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N.C.D Program for Prevention & Control of
Diabetes & Hypertension Status & Strategies
Dr. S.Sajith Kumar MD
Associate Professor in Community Medicine
T.D. Medical College,Alappuzha
Trends & Projections of NCDs in India
Diabetes• 2000: 32 million (WHO)• 2010: 51 million (International Diabetes Federation)• 2030: 80 million (WHO)
Cardio-vascular Diseases• 1998: 19 million (ICMR)• 2005: 38 million (Nat. Com. Macroeconomics & Health)• 2015: 64 million (Nat. Com. Macroeconomics & Health)
Cancer• Estimated number of persons with cancer: 2.8 million• Annual Incidence: 1 million
Percentage of NCD deaths, by cause in WHO Regions, 2008
0%
20%
40%
60%
80%
100%
% o
f De
ath
Other NCDs
Diabetes
Respiratorydiseases
Cancers
Cardiovasculardiseases
Four major NCDs cause 80% of deaths due to NCDs in all WHO RegionsSource: WHO global Health observatory 2011 http://apps.who.int/ghodata/
Distribution of deaths by major cause-India 2001-2003
Deaths due to NCDs outnumber deaths due to communicable diseases, maternal and perinatal
causes and nutritional conditions combined
Others 9.9% (N=11,242)
Communicable disease, maternal
& perinatal conditions, nutritional
deficiencies38.2%
(N=43,390)
Noncommunicable disease42.4%
(N=48,170)
Injuries9.6%
(N=10,890)
Source: RGI-CGHR Million Death Study
Disease Burden due to NCDs
• More than 20% of the population have at least one chronic disease
• More than 10% have more than one chronic disease
Mortality estimates due to NCDs
• Globally all deaths (2005) 58 million*• Globally deaths due to NCD (2005) 35 million*
(60.3%)
• All deaths in India (2004) 10.3 million #
• Deaths due to NCDs in India (2004) 5.2 million # (50.5%)
* Source: WHO
# Source: ICMR
Cancer Scenario: India
• Incidence: 10 lakhs /yr• Prevalence: 28 lakhs• Deaths from cancer: 5 lakh / year • Age group affected: 60-70% in 35-64 years • Tobacco related cancers about 40 %• 2/3rd cases in advance stage at the time of
diagnosis
• Common Cancers Breast, uterine cervix & oral cavity in females Oral cavity, lung & oesophagus in males
Gaps in the natural history of NCDWeb of causation
Changes in life style stress
Abundance of food lack of physical activity smoking emotional
disturbance
aging
Obesity hypertension
Hyperlipidemia thrombotic tendency
changes
artery walls
Coronary arthrosclerosis coronary occlusionMyocardialinfarction
Gaps in the natural history of NCD3. Long latent period: it is the period
between the first exposure to suspected cause and the eventual development of disease. This makes it difficult to link suspected causes with outcomes.
4. Indefinite onset : Most (NCD) are slow in onset and development. Distinction between diseased and non diseased may be difficult to establish.
Prevention of NCDLevels of prevention1. Primordial
2. Primary
3. Secondary
4. Tertiary
1. Primordial prevention- Prevention of the emergence or development of risk factors in countries or population groups in which they have not yet appeared. Efforts are directed towards discouraging children from adopting harmful life styles.
2. Primary prevention- Action taken prior to the onset of disease which removes the possibility that the disease will ever occur. Can be divided into population & high risk strategy.
For healthy people
For unhealthy people
Prevention of NCDInterventions:• Health promotion• Specific protection• Adequate nutrition• Safe water and sanitation
3. Secondary prevention-Action which halts the progress of the disease at its incipient stage and prevents complications. Mostly curative. Disadvantage - patient has already suffered mental & physical anguish & community to loss of production. Often more expensive &less effective. Intervention – EARLY DIAGNOSIS AND TREATMENT
4. Tertiary prevention- defined as all measures available to reduce impairments & disabilities, minimize suffering due to departure from good health & promote patient’s adjustment to irremediable conditions.Intervention – DISABILITY LIMITATION AND REHABILITATION
Primary prevention
DiseaseDiseaseOutcomesOutcomes• Heart disease• Stroke• Diabetes• Cancer• Chronic resp.
disease
Physiological RFPhysiological RF• BMI (obesity)• Blood pressure• Blood glucose• Cholesterol
Behavioral RFBehavioral RF• Tobacco• Alcohol• Physical
inactivity• Diet
The causal chain
Primary prevention
(Health Promotion)
Secondary prevention(Case management &
Health promotion
Tertiary prevention
(Tertiary care)
Risk factors and level of NCD prevention Risk factors and level of NCD prevention and managementand management
Objectives
1. To prevent and control common NCDs through behavior and lifestyle changes
2. To provide early diagnosis and management of common NCDs
3. To build capacity at various levels of health care facilities for prevention, diagnosis and treatment of common NCDs
4. To develop trained human resource within Public Health set up
5. To establish and develop capacity for palliative & rehabilitative care
14
Components
• Prevention through behaviour change
• Early Diagnosis
• Medical treatment
• Capacity building of human resource.
• Supervision, monitoring and evaluation
Strategies of Programme
• Promotion of healthy lifestyle through behaviour change
• Opportunistic screening of persons above 30 yrs • Comprehensive examination, diagnosis and
management of cancer, diabetes, cardiovascular diseases and stroke
• Development of trained manpower • Strengthening of tertiary level health facilities • Programme management at centre, state and district
Implementation
5000 Sub-Centres
164 Community Health Centres
1000 PHC’s
14 Districts
Key Interventions for implementation of NPCDCS
Key Area Activities
Health Promotion
Public awareness through multi-media Counseling for healthy lifestyle (Balanced diet,
regular exercise, avoid alcohol and tobacco)
Early Diagnosis Screening of persons above 30 years and all pregnant women for diabetes and hypertension at all levels; facilities up to Sub-centre level
Case Management
Facilities for diagnosis and treatment
Capacity Building
Infrastructure Development & Equipment Training of human resources at all levels
Management & Monitoring
Surveillance, monitoring & evaluation Regular review meetings
Community Awareness • Training of health workers namely ASHA, ANM, and
Male Health Workers
• Health promotion activities in community, school and workplace settings through IPC, education, mass media etc.
• Opportunistic screening using measurement BP for hypertension and blood glucose by strip method for diabetes at community level
• Patient referral cards to facilitate referral & follow-up
NCD Services at Sub- Centre
Infra structure available
ANM (1) , Male Health worker(1)
Services proposed
• ‘Opportunistic Screening’ of > 30 years:
• NCD risk factors (dietary habits ,physical inactivity, alcohol abuse and tobacco use)
• Diabetes by blood sugar strip method
• Blood Pressure
• Referral to CHC