ROLE OF MEDICAL WOMEN ASSOCIATION OF NIGERIA IN NON-COMMUNICABLE DISEASES

BY PROF. G.C. ONYEMELUKWE (MON)

CHAIRMAN, NATIONAL EXPERT COMMITTEE ON CHAIRMAN, NATIONAL EXPERT COMMITTEE ON NON-COMMUNICABLE DISEASESNON-COMMUNICABLE DISEASES

AREWA HOUSE KADUNA23RD NOVEMBER 2004

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LIST OF NON COMMUNICABLE DISEASES

1. Hypertension2. Diabetes Mellitus3. Sickle Cell Disease4. Mental ILL Health & drug

abuse 5. Asthma6. Violence (Road traffic

accident, domestic, conflict

7. Blindness8. Oral Health9. Rheumatic

fever/rheumatic heart disease

10. Coronary heart disease11. Cerebrovascular disease

(stroke)12 Heart Disease

a. Cardiomyopathiesb. Endomyocardial fibrosisc. Peripartum Cardiac

failure (PPCF)13. Cancers

a. Hepatoma b. Prostate c. Cervix d. Breast

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MORTALITY STATISTICS (1999-2001) ABUTH, ZARIA (Source: Community Medicine)

1. Road traffic Accidents 14.25%

2. Infections and Septicaemia 10.80%

3. Hypertension 9.32%

4. Protein calorie malnutrition 8.53%

5. Tuberculosis 5.09%

6. HIV/AIDS 4.75%

7. Cancers 4.07%

8. Mellitus 3.29%

9. Cerebrovascular Accidents (Stroke)

2.35%

*44% of deaths are due to NCDs

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*2003 SURVEILLANCE DATA LAGOS (SW ZONE)

BP systolic =>140mmHg

BP diastolic =>90mmHg

Female : 22.6%Male : 22.1%

Female: 29.5%Male : 30%

Rural (all) : 13.7%Urban (all): 28.7%

Rural : 20.6%Urban : 36.9%

* Risk of CVS damage doubles for every 10 point increase in diastolic and 20 point systolic increase.* ¼ to 1/3 of women in rural and urban areas are hypertensive.

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NATIONAL MENTAL HEALTH SURVEY

• DEPRESSION SYMPTOMS HIGH (Female>male)

• ANXIETY SYMPTOMS HIGH

NB: Severe depression can lead to violence and suicide

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BURDEN OF NON COMMUNICABLE DISEASE (DALYs) %DISTRIBUTION IN SUB SAHARAN AFRICA

0

10

20

30

40

50

60

70

1990 2000 2010 2020

Source: Murray & Lopez: Global burden of Disease

NCDs

Communicable

Injuries

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WHAT IS RISK FACTOR?• A risk factor is a condition that places

an individual at risk of developing a health related problem.

• A risk factor can be genetic or acquired. It may be identified as a single measurement (e.g. a physical feature such as weight), a disease (e.g. Hypertension) or a lifestyle characteristics (e.g. smoking)

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WHAT IS RISK FACTOR? Cont.

• In order to be considered a risk factor for a disease, the condition must be associated with that disease in a manner which is beyond chance alone.

• A casual link is therefore implied• A risk factor will however not necessarily

lead to the development of the disease• Risk factors/habits begin in youth/in

womb.

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RISK FACTORS IN NCD’s IRisk Factors Hypertension Diabetes

Mellitus Strokes Cancer CAD Mental

IllnessViolence Heart

Disease/ PPCF

Physical inactivity

√ √ √ √ √ √ √ √

Alcohol Excess √ √ √ √ √ √ √ √Drug Abuse/Use √ √ √ √ √ √ √ √Tobacco Use/Smoking

√ √ √ √ √ √ √ √

Salt Excess √ X √ X √ X √ √Unhealthy Diets √ √ √ √ √ √ √ √Obesity √ √ √ √ √ √ √ √Abnormal Blood Lipids

√ √ √ √ √ √ X √

Psychological Stress

√ √ √ √ √ √ √ √

Low Economic Status

√ √ √ √ √ √ √ √

Unsafe Sex X X √ √ √ √ √ √Age √ √ √ √ √ √ √ √Family History/Heredity

√ √ √ √ √ √ √ √

Gender √ X X √ √ √ √ √

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RISK FACTORS IN NCD’s IIRisk Factors Asthma/COPD Sickle Cell

DiseaseBlindness Oral

HealthOsteoporosis/Nutrition

Physical inactivity √ X X X √

Alcohol Excess X X √ √ √

Drug Abuse/Use √ X √ √ √

Tobacco Use/Smoking

√ X √ √ √

Salt Excess X X X X X

Unhealthy Diets √ X √ √ √

Obesity √ X X X √

Abnormal Blood Lipids

X X X X X

Psychological Stress √ X √ √ √

Low Economic Status

√ X √ √ √

Unsafe Sex X X X √ X

Age √ X X √ √

Family History/Heredity

√ √ √ √ √

Gender X X X X √

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REASONS FOR EXPLOSION OF NCDs

1. Western Lifestyle Leading to INSULIN RESISTANCE

2. ROLE OF INFECTIONS Cancer Liver HBV, HBC (25-40% CARRIERS) Cervix – Papilloma/Herpes genitalis Bladder – Schistosomiasis Coronary artey disease – Chlamydia Rheumatic heart disease – streptococci Blindness – filaria/chlamydia.

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3. CULTURAL Large body image “pot” belly/ “cash madam” Cultural pre-matual fattening

“Kunu Kanwa” heating postpartum heart failure “Mai – Shanu” consumption lipidemia Traditional African cooking vitamins antioxidants

destroyed 4. INTRAUTERINE LOW BIRTH WEIGHT (BAKER’S HYPOTHESIS – Stress, infection, under-

nutrition, smoking.5. NUTRITIONAL TRANSITION CHILD STUNTING; REFEEDING – SHORT OBESE

ADULT

REASONS FOR EXPLOSION OF NCDs Cont.

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GENES

HIGH RISK BEHAVIOUR

LACK OF EXERCISE

DRUG ABUSE

1. PHYSICO-CHEMICAL-MICROBIAL ENVIRONMENT2. PSYCHOSOCIAL ENVIRONMENT3. INTRAUTERINE ENVIRONMENT

SMOKING

ALCOHOL

CHILDHOOD UNDER NUTRITION

FETAL UNDER NUTRITION

UNSAFE SEX

HIGH SALT

HIGH FAT

HIGH STRESS

OBESITY, HYPERTENSION, DIABETES,ASTHMA, CANCERS, MENTAL ILL-HEALTH,CORONARY ARTERY DISEASE OSTEOPOROSIS ETC

ENVIRONMENT

VS

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TEN COMMAND CIVIC DUTIES OF ALL NIGERIANSTEN COMMAND CIVIC DUTIES OF ALL NIGERIANS S/N DUTIES BENEFITS

1. Exercise daily (including walks) Prevention of hypertension, diabetes, obesity, mental ILL health, cancers etc.

2. Know blood pressure from age 30 and above (annually/six monthly)

Detect hypertension early (blood pressure increases with age)

3. Know blood sugar from age 40 years Detect diabetes mellitus (blood sugar increases with age)

4. Know sickle cell genotype of all family For counseling of family

5. Monthly breast self examination by females from age 17 To detect lumps and early breast cancer

6. Know presence of hepatitis B surface antigen in blood of family members

Prevent liver cancer and other diseases.

7. Know prostate specific antigen (PSA) blood level (men 50 years)

To detect prostate cancer

8. Women screen cervical smear (PAP Smear) every 2 – 3 years

To prevent, detect early cervical cancer.

9. Know blood cholesterol by obese or overweight people from age 40 years

Prevent coronary heart disease

10. Know body mass index (BMI) (weight in kg

Height x height (mtrs)

To watch nutritional excess or deficiency

Issued by NCD Expert Committee on Non-Communicable DiseaseNote: BMI >30kg/mtr2 is Obesity

BMI >25kg/mtr2 is overweight BMI <18.5kg/mtr2 shows under-nutrition

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• POLITICAL WILL – Lack IN STATES of NCDs, SILENT KILLERS CARING/COMPASSIONATE SOCIETY

• FIRM VOICE; FIRM AGENDA BY (WOMEN)• STRATEGIC GATES OF WOMEN AND

CONSEQUENCES 1. Gate to stomach 2. Gate into world (womb – intrauterine) 3. Gate to Child/Family Destiny – Children

risk factors

4. Gate to Domestic Finance

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CONCLUSION ROLES:1. INFORMATION, EDUCATION,

COMMUNICATION – RADIO TALKS2. SCREENING3. LIFESTYLE RISK FACTOR MODIFICATION

(MULTIFACTOR APPROACH)4. RESEARCH IN WOMEN HEALTH – BRITISH

WOMEN/USA DONE5. NATIONAL ACTION ON TOBACCO

CESSATION6. HEPATITIS B VACCINATION OF CHILDREN

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MAY GOD’S PUPPOSE FOR NIGERIA BE PERFORMED