NonCommunicable Diseases Control Program K R Thankappan MD
Non-Communicable Diseases Control Program _________________ K R Thankappan MD, MPH Additional Professor and Head Achutha Menon Centre for Health Science Studies Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum
Death, by broad cause group, 1999 Noncommunicable conditions (59. 8%) Communicable diseases, maternal and perinatal conditions and nutritional deficiencies (31. 1%) Injuries (9. 1%) Source: WHO Report 2000
Global burden of disease in disability-adjusted life years (DALYs), 1999 Noncommunicable conditions (43. 2%) Communicable diseases, maternal and perinatal conditions and nutritional deficiencies (42. 8%) Injuries (13. 9%) Source: WHO Report 2000
Deaths, by broad cause group and WHO Region, 1999 % Noncommunicable conditions 75 Injuries Communicable diseases, maternal and perinatal conditions and nutritional deficiencies 50 25 AFR EMR SEAR WPR AMR EUR Source: WHO 2000
DALYS, by broad cause group and WHO Region, 1999 DALY = Disability adjusted life-year 75 % Noncommunicable conditions Injuries Communicable diseases, maternal and perinatal conditions and nutritional deficiencies 50 25 AFR EMR SEAR WPR AMR EUR Source: WHO 2000
DALYs, by broad cause group 1990 - 2020 in developing countries (baseline scenario) DALY = Disability-Adjusted Life Year % 49 % Communicable diseases, maternal and perinatal conditions and nutritional deficiencies 22 21 Injuries 14 15 Neuropsychiatric disorders 9 27 Noncommunicable conditions 43 Source: WHO, Evidence, Information and Policy, 2000
Low- and middle-income countries suffer the greatest impact on non-communicable diseases 77% of the total number of deaths attributable to NCDs occurred in developing countries 85% of the global NCD disease burden borne by low- and middle-income countries Source: WHO: , 2000
Distribution of causes of death in South-East Asia, 1999 (000 s) Injuries (1301) Noncommunicable conditions (7370) Other causes (236) Perinatal conditions (851) Nutritional deficiencies (159) Malaria (69) HIV/AIDS (360) Tuberculosis (723) Diarrhoeal diseases (978) Respiratory infections (1523) Childhood diseases (542) Maternal conditions (158) Source: WHO 2000
Burden of disease in disability-adjusted life years (DALYs) in South-East Asia, 1999 (000 s) Injuries (65289) Noncommunicable conditions (156536) Other causes (19693) Perinatal conditions (32715) Nutritional deficiencies (16866) Malaria (3071) HIV/AIDS (8866) Tuberculosis (14101) Diarrhoeal diseases (30017) Respiratory infections (38144) Childhood diseases (19449) Maternal conditions (7733) Source: WHO 2000
Cardiovascular (CVD) epidemic in countries of different stages of development -----1940 -----1950 -----1960 -----1970 -----1980 -----1990 -----2000 ----High Income Economies in Transition Middle and Low Income Countries Rapid increase Slow increase Low rates Reach the peak Progressive decline Reach First cause the peak of death & in some disability countries Rapid increase Slow increase Remains as first cause of death & disability Rapid increase in most countries First cause of death & disability in most countries
DALYs, by broad cause group 1990 - 2020 in developing countries (baseline scenario) % 50 1990 2020 25 DALY = Disability adjusted life-year Communicable diseases, maternal and perinatal conditions and nutritional deficiencies Injuries Noncommunicable conditions Source: WHO, Evidence, Information and Policy, 2000
Source: K S Reddy. Lancet 1998.
Coronary Heart Disease Prevalence Studies in India (Urban) Study Year Sample CHD Prevalence Agra 1960 1046 Delhi 1962 1642 Chandigarh 1968 2030 Rohtak 1975 1407 Delhi 1990 13723 Jaipur 1995 2212 Moradabad 1995 152 Trivandrum 1995 506 ____________ Source: Gupta et al. Indian Heart Journal 1995. 11 1. 05 17 1. 04 134 6. 60 51 3. 63 1327 9. 67 168 7. 59 13 8. 55 41 12. 65
Prevalence Of Hypertension in the elderly Loacation % 95% CI Kerala Urban 69 (63 -75) Kerala Rural 55 (49 -61) Maharashtra Urban 72 (69 -75) Dhaka Urban 65 (62 -67) Dhaka Rural 53 (47 -59) __________________ Source. Hypertension study group AMCHSS of SCTIMST. WHO Bulletin 2001.
Prevalence of Hypertension (40 -60 Yrs) Trivandrum City Age group 40 -44 45 -49 50 -54 55 -60 Total Prevalence 42. 2 55. 3 55. 7 67. 2 54. 5 Manu Zachariah, Thankappan K R et al. Indian Heart Journal 2003
Non-modifiable Risk Factors Cardiovascular risk factors • Age • Male gender • Genetic predisposition Behavioural Risk Factors • Smoking • Unhealthy diet -High in saturated fat & salt -Inadequate intake of fruits and vegetables • Excessive alcohol use • Sedentary life-style Modifiable Risk Factors • Hypertension • Elevated LDL cholesterol • Decreased HDL cholesterol • Diabetes • Insulin resistance • Obesity Adverse Socio-economic, Cultural & Environmental Conditions Endpoints • Hypertensive heart disease • Coronary heart disease • Cerebrovascular disease (Stroke) • Peripheral vascular disease
Tobacco: deaths by World Bank regions estimates for 1990 and 2020 8. 4 million Middle Eastern Crescent Latin America & Caribbean Sub-Saharan Africa Other Asia and Islands China 3 million India Former Socialist Countries Established Market Economies Source: Murray CJL, Lopez AD 1996
Tobacco use and educational level among females in Bombay 1992 -1994 Users % Source: Gupta, 1996
Body Mass Index in Indian Women 15 -49 Years. State BMI <18. 5 BMI 25+ BMI 30+ Delhi Punjab Kerala Orissa Assam Bihar India Urban Rural Source: NFHS 1998 -99. 12. 0 16. 9 18. 7 48. 0 27. 1 39. 3 35. 8 22. 6 40. 6 33. 8 30. 2 20. 6 04. 4 04. 2 03. 7 10. 6 23. 5 05. 9 9. 2 9. 1 3. 8 0. 6 0. 7 0. 5 2. 2 5. 8 0. 9
No National Program for NCD More than 50% of disease burden in India is due to NCDs Many National Programs for Communicable diseases
How to address Monitoring of Risk factors Tobacco Use Diet (Fruits and Vegetables) Body Mass Index Physical activity Blood Sugar Blood Lipid levels
Disease Specific Program Cancer Diabetes Bronchial Asthma Hypertension?
Need to develop a Program Sentinel Health Monitoring Centres Assam Delhi Kerala Maharashtra Tamil Nadu
Address Risk factors and determinants at community level Inter-sectoral coordination
Legislation For example Tobacco Control Alcohol Diet, salt restriction Exercise
Global strategy for Diet and Physical activity
Primary Health Care System Need to re-orient focus Training of health workers Monitoring of blood pressure and urine sugar can be done at grass root level Health education programs
Capacity Building Manpower -PH specialists New Public Health Schools Social Science components MPH-SCTIMST, Allahabad PGI Chandigarh, CMC Vellore, EHA Expand the current MD programs FETP Programs- MAE at NIE
Start From Children
THANK YOU
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