Non Communicable Diseases in NigeriaImpact and Prevention Professor

Non Communicable Diseases in Nigeria-Impact and Prevention Professor Fatimah Abdulkareem, Department of Anatomic & Molecular Pathology College of Medicine of the University of Lagos/Lagos University Teaching Hospital Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 1

Objectives/outline � Definition � Global of NCDs trends in NCDs � Definition factors & risk factors and metabolic risk � Common risk factors for NCDs � In-depth discussion of 3 common NCDs � Prevention strategies Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 2

Definition of Non Communicable Diseases (NCDs) �NCDs are diseases that do not result from acute infective process, have prolonged course, do not resolve completely and for which complete cure is rarely achieved (Mc. Kenna, et al, 1998) Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 3

Characteristics of NCDs Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 4

Types of NCDs � Cardiovascular(stroke, heart attack) 17. 7 M Deaths � Cancer 8. 8 M � Chronic Respiratory diseases (e. g. asthma) 3. 9 M � Diabetes mellitus 1. 6 M � Chronic neurological disorders (Alzeihmer’s, Dementia � Arthritis/musculoskeletal diseases Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 5

Global trends � The 4 major categories below represent about 80% of NCDs � According to WHO, NCDs account for about 70% of global deaths with about 17 of the 40 million deaths occurring in persons below 70 years and 87% of these occur in low- and middle-income countries such as Nigeria. Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 6

Who is at risk? � People of all regions and countries are affected by NCDs � Children, adults and the elderly are all vulnerable to the risk factors contributing to NCDs � 15 million of all deaths attributed to NCDs occur between the ages of 30 and 69 years; the most productive age grp Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 7

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Risk factors � Defined as an aspect of personal behaviour or lifestyle, environmental exposure or hereditary characteristics that are associated with increased occurrence of diseases � Risk factors for NCDs are: ◦ Non modifiable ◦ Modifiable-behavioral and metabolic Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 13

Risk factors � Age � Gender � Race � Family historyheredity Modifiable behavioral risk factors � Tobacco � Physical use, inactivity � Unhealthy diet and � The harmful use of alcohol Non-modifiable risk factors Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 14

Metabolic risk factors � Raised blood pressure � Overweight/obesity � Hyperglycemia (high blood glucose levels) and � Hyperlipidemia (high levels of fat in the blood). Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 15

Underlying determinants � Globalization � Urbanization � Population ageing � Social determinants Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 16

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� Kills 50% of its users � Tobaccounts for 7. 2 million deaths every year (including from the effects of exposure to secondhand smoke). � Nearly 80% of the world’s I billion smokers live in low and middle –income countries Tobacco Health Effects Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 20

Carcinogens in cigarette Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 21

1. 6 million deaths annually can be attributed to insufficient physical activity. Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 22

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Healthy Diet include: Fresh fruits and vegetables, lean meats, fish, and whole grains Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 24

More than half of the 3. 3 million annual deaths due to alcohol use are from NCDs, including cancer. Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 25

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CVDs are the No 1 cause of death worldwide � 17. 3 million people died from CVD in 2008, 30% of all global deaths. ◦ 7. 3 million were due to heart attacks ◦ 6. 2 million due to stroke. � 80% of these deaths occurred in low- and middle income countries, � By 2030, almost 25 million people will die from CVD Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 30

� Cardiovascular disease is caused by narrowed, blocked or stiffened blood vessels that prevent your heart, brain or other parts of your body from receiving enough blood. https: //www. pdhpe. net Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 31

Cardiovascular diseases include � Raised blood pressure (hypertension), � Cerebrovascular disease (stroke) � Coronary heart disease (heart attacks) � Peripheral artery disease, � Rheumatic heart disease � Congenital heart disease � Heart failure Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 32

Pioneer lecture Iseyin- Prof http: //www. championadvocates. org Abdulkareem, Unilag 12/27/2021 33

Risk factors of CVD Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 34

Diabetes Mellitus � Diabetes is a disorder of metabolism (the way the body uses food for growth & energy) ◦ Results from either inability of the pancreas to produce enough insulin, or when the body cannot effectively use the insulin it produces raised glucose levels in the blood Longterm damage to the body and failure of various organs and tissues. � There are 4 types: Type 1, Type 2, Pregnancy Related and Impaired Glucose tolerance � Type 2 accounts for 80% of all cases worldwide � Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 35

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Cancer � Defined as: �“Rapid creation of abnormal cells that grow beyond their usual boundaries and which can then invade adjoining parts of the body and spread to other organs” (WHO 2012) Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 39

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Cancer trends(globocan. iarc. fr) � The 2012 Global Cancer Statistics published in 2014 showed that 14. 1 million new cancer cases were diagnosed and 8. 2 million cancer deaths worldwide in 2012. � Of the new cases, 57% of the world total occurred in the less developed regions such as Nigeria � 5. 3 million people died from cancer (65% of the global total). � By 2025, 19. 3 million new cancer cases are expected to be diagnosed each year. Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 41

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The five most common cancers in Nigeria in both males and females together are(Global cancer statistics) �Breast-26. 7% �Cervix �Liver -13. 8% -11. 8% �Prostate-11. 7% �Colorectal -4. 1% Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 44

In Nigeria, incidence is increasing, pattern is changing � Increasing incidence has been reported from Nigeria and yet it is still underreported. � Cancer occurs in females 2 xs more than in males � Increase actual or relative: Actual increase due to increase exposure to the risk factors Better awareness which make patients report at the hospital Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 45

Data from 2 Population-based cancer registries in Nigeria, Jeddy-Egba et al 2012 Ibadan Cancer Registry � 34% male, 66% females � Mean Abuja cancer Registry � 33. 6% in males, 66. 4% in females � Mean age: 49. 9 yrs age: 51. 1 yrs The study suggests substantial , (100%) increase in incidence of breast cancer in the last decade Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 46

Risk factors of cancer- are 2 ◦ Hereditary –a person can inherit a gene that predisposes to cancer such as in breast, colon, ovary and prostate cancers ◦ Exposure to environmental factors such as micro-organisms, diet and tobacco ◦ In Africa, 37% of cancer deaths are due to diet, tobacco and infections ◦ These are referred to as preventable or modifiable causes of cancer Pioneer lecture Iseyin- 12/27/2021 47

List of Micro-organisms and Associated Cancer Micro-organism Helicobacter pylori Associated Cancer two types of stomach cancer Hepatitis B or C virus Liver cancer Human Papilloma Virus Cervical cancer Epstein Barr virus Burkitt’s lymphoma, Head & Neck cancer HIV High grade B cell Lymphoma Schistosoma haematobium Cancer of the bladder Pioneer lectureurinary Iseyin- Prof 12/27/2021 Abdulkareem, Unilag 48

Cancer of the liver Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 4 9

Advanced stomach cancer Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 50

Environmental factors Type Risk factor Type of Cancer Chemicals Benzene blood cancer (leukaemia) bladder cancer Dyes Radiations- Pollution from burning fuels Ultraviolet and X cancer of the -ray skin, breast and thyroid Cancer of the lungs Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 51

Social factors � Tobacco-cancer of the lungs, mouth, stomach, pancreas, breast, cervix � Alcohol-cancer of the liver, stomach and breast � Obesity � Early or overweight-breast, colon, womb exposure to sex-cancer of the cervix � Multiple sexual partners-cancer of the cervix, liver (through HPV and hepatitis B virus) � Unhealthy diet, inactivity or inadequate exercise Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 52

Dietary risk factors for cancer � Overweight and obesity are associated with colon, breast, uterus, oesophagus and kidney cancers. � Westernized food which is high in animal protein and fat are major risk factors for colorectal cancer. � Eating of smoked and salted food in form of ‘barbecue meat’, ‘suya’ or ‘kilishi’ or ‘eran oniyo’, ‘smoked fish’ may also predispose to cancer of the stomach. Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 53

�Lack/inadequate intake of fresh fruits and vegetables �Aflatoxin from improperly preserved grains such as groundnut is associated with liver cancer particularly in the presence of hepatitis B virus Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 54

Breast cancer-advanced Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 55

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Modifiable risk factors-breast cancer Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 57

Cervical cancer Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 58

Predisposing/risk factors to cervical cancer � Genital tract HPV infection in >90% of cases (hence the slogan ‘no HPV, no cervical cancer’) �Early exposure to sexual intercourse. �History of multiple sexual partners. � Cigarette � Poverty smoking � Poor nutrition and lack of micronutrients. � Immune deficiencies (e. g HIV) Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 59

Normal cervix (left), invasive cancer cervix(right) Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 60

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Prostate cancer –risk factors 62 �Black race, �age above 40 years, �positive family history, �Obesity �high fat diet �high serum androgens levels; the latter being most consistent. 12/27/2021 Pioneer lecture Iseyin- Prof 12/27/2021 Abdulkareem, Unilag 62

Symptoms of prostate cancer � Difficulty starting urination. � Weak or interrupted flow of urine. � Frequent urination, especially at night. � Difficulty emptying the bladder completely. � Pain or burning during urination. � Blood in the urine or semen. � Pain in the back, hips, or pelvis that doesn’t go away. � Painful ejaculation. Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 63

Screening for Prostate cancer � Digital rectal exam (DRE): ◦ Examination of the prostate through the anus to estimate the size and feel for lumps or other abnormalities. � Prostate specific antigen (PSA) test: ◦ Measures the level of PSA in the blood. ◦ levels of PSA in the blood can be higher in men who have prostate cancer although the level may also be elevated in other conditions that affect the prostate. Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 64

Prevention of cancer � Prevention is divided into primary, secondary and tertiary � Primary prevention ◦ Lifestyle modification�alcohol, �tobacco, �sexual activity, �good diet, �exercise etc ◦ Vaccination-e. g- Hepatitis B vaccine for liver cancer, HPV vaccine for cervical cancer Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 65

Prevention of cancer cont. Secondary prevention- Early detectionscreening e. g. �Breast Self examination(BSE), breast scan & mammogram in breast cancer. �Pap smear, VIA(visual inspection with acetic acid) in cancer of the cervix �PSA test for prostate cancer �Ultrasound scan of liver, Feacal occult blood test and endoscopy for GIT Cancer Tertiary Prevention�Prompt treatment, �palliative care. . Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 66

Cancer prevention Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 67

Prevention of breast cancer � Lifestyle modification-good diet, no tobacco, exercise � Early detection- ◦ breast self examination (BSE) Breast self examination for every woman including young girls ◦ Clinical breast examination every 1 -3 yrs from age 20 -39; high risk – medical examination yearly ◦ Mammography screening � Prophylaxis-tamoxifen � Prompt treatment in at risk women Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 68

Breast Self Examination Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 69

Mammography screening every 1 -2 yrs for women >40 yrs or <40 yrs for women at risk Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 70

Cervical cancer screening-Pap smear Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 71

When to do Pap smear � Should be done: � Annually in women > 18 yrs or with commencement of sexual activity � mid-cycle or second half of the cycle � No sexual intercourse 24 hrs before � No douching 24 hrs before. Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 72

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HPV-DNA testing �This is used for women above 30 yrs �Positive cases can be further investigated �Negative HPV-DNA testing can be repeated after 5 -10 yrs Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 74

General tips on healthy cancerfree lifestyle Do not pick up tobacco use (particularly smoking, if you have started, stop!). Maintain normal body weight, weigh yourself regularly Do not overeat (even if food is free!). Eat at least 2 servings of fresh fruits and vegetables daily. Reduce red meat and animal fat in your diet (2 ce a week). Eat more of poultry, or fish. Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 75

Cancer-free lifestyle cont � Include pulses (e. g. beans) in your diet, serve at least 3 meals of beans a week. � Ensure your meal times are regular � Increase your level of physical activity – opportunities abound in all aspects of your daily life domestic, work, transport and leisure, engage in physical activity to the point of “slight panting” for 30 minutes: this can be accumulated through the day. � Remain faithful to your partner, if you are not married, “zip up” or “keep fasting”. Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 76

Socioeconomic impacts of NCDs Premature deaths threaten progress towards the 2030 Agenda for Sustainable Development Vulnerable people are at greater risk of exposure NCD s Healthcare cost drains family resources POV ERTY The poor have less access to healthcare POVERTY Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 77

Prevention of NCDs-Role of WHO � To support countries in their national efforts, WHO developed a Global action plan for the prevention and control of NCDs 2013 -2020, which includes nine global targets that have the greatest impact on global NCD mortality. � These targets address prevention and management of NCDs. Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 78

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Conclusion • NCDs are the leading cause of death in the world. • The 4 major types kill 3 in 5 people worldwide. • Premature deaths from NCDs, however, can be prevented by changed policies and active engagement not only in health but also in other sectors. • Effective action will save millions of lives http: //www. who. int and avoid suffering. Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 82

Thanks for listening Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 83

References � Overview of non communicable diseases and related risk factors. https: //www. cdc. gov/globalhealth/. . . 8/overvi ew-ncds_fg_qa-review_091113. pdf � Non communicable diseases and their risk factors. www. who. int/mediacentre/factsheets/fs 355/ en/ Pioneer lecture Iseyin- Prof Abdulkareem, Unilag 12/27/2021 84