Non communicable diseases - dr. anindya

Dr. Anindya Debnath

Medical Officer

India

NON-COMMUNICABLE DISEASES

April 10, 2023NCDS- DR. ANINDYA 2

1. Objectives

2. Introduction

3. Magnitude Of The Problem

4. Age Distribution of NCDs

5. Common Risk Factors

6. Coronary Heart Disease

7. Hypertension

8. Stroke

9. Obesity

10. Diabetes

11. Accidents and Injuries

12. Malignancies

13. Blindness

14. Psychiatric disorders

15. Other NCDs Among Elderly

16. Prevention of NCDs

INDEX


OBJECTIVES

• To get an idea about the magnitude of the problem

• To know the risk factors responsible

• Methods of prevention of NCDs


INTRODUCTIONSynonyms: “Chronic” diseases”,

“Lifestyle Diseases”

With rapid urbanization, industrialization and increasing level

of affluence (the so called “modernization”), the price that the

society is paying is a tremendous load of “Non - Communicable”

diseases.

Global phenomena -not simply restricted to the developed, rich countries.

In the context of our country, too, the problem of lifestyle and its

consequent diseases is assuming the position of a new “EPIDEMIC”.


MAGNITUDE OF THE PROBLEM

• Prevalence is INCREASING in most of the Developed as well as Developing Countries. A New “Epidemic” REASON?

• Cardiovascular Diseases and Cancer - Leading causes of death in most of the developed countries (70 to 75% of total Deaths).

• Developing Countries- Following the same steps to the trap(!!) in a far more pitiable fashion. HOW?-Cause, we have CDs, NCDs and Poverty- all 3 burdens to be taken SIMULTANEOUSLY.


Younger Age-group• Accidents and Injuries

• Rheumatic Heart Disease

• Diabetes

• Blindness

• Psychiatric disorders

Elderly• Hypertension

• Coronary Heart Disease

• Diabetes

• Stroke

• Malignancies

• Obesity

• Blindness

• Psychiatric disorders

• Others

AGE DISTRIBUTION OF NCDS


NON-MODIFIABLE• Age

• Sex

• Family History

• Genetic Factors

• Personality

MODIFIABLE• Cigarette Smoking

• Alcohol Abuse

• Dyslipidemia

• Sedentary Life Style

• Stress

• Environmental Risk Factors

• Inability to avail preventive health care services

COMMON RISK FACTORS


CORONARY HEART DISEASE

• Problem Statement: 30% of deaths in men; 25% of death in female in Western Countries.

• INDIAN SCENARIO: Leading cause of death and disability in our country, by the year 2025.

• Presentations:

Angina Pectoris

Myocardial Infarction

Arrhythmia

Cardiac Failure

Sudden Death


HYPERTENSION

• Classification:Category Systolic BP Diastolic BP

(mm Hg) (mm Hg)

Normal <130 <85

High Normal 130-139 85-90

Hypertension

Stage 1(Mild) 140-159 90-99

Stage 2(Moderate) 160-179 100-109

Stage 3(Severe) >180 >110


HYPERTENSION (CONTD..)

• GLOBAL BURDEN: About 10% to 20% population.

• INDIAN SCENARIO:

Male Female

Urban 6% 7%

Rural 3.5% 3.6%

Urban Rural01234567

MaleFemale



Rule of Halves.

Non hypertensive

Hypertensive (Not diagnosed)

Diagnosed but Untreated HypertensiveInadequately Treated Hypertensive

Adequately Treated Hypertensive



• “Tracking” of Blood Pressure.

Bloo

d Pr

essu

re

Time


STROKE

• Problem Statement: 10% to 12% of all deaths in Developed Countries.

• In India: Over all prevalence of stroke appears to be comparatively less (1.54/1000 against 0.2-2.5/1000 world-wide)

BUT

The proportion of stroke among young age-group is significantly more.


STROKE (CONTD..)• Etiopathological types:

Hemorrhagic

Thrombotic

Embolic

• TRANSIENT ISCHEMIC ATTACKS (TIA)

Sudden onset

Focal

Reversible neurological deficit

Duration<24 hours

Cause: Micro-emboli

Significance: WARNING SIGN OF STROKE!!!


OBESITY

• Abnormal growth of adipose tissue.

OBESITY

Hypertrophic Hyperplastic

OBESITY

Android Gynoid


OBESITY (CONTD..)• Magnitude: (Developed Countries)

Adults 20% to 40%

Children 10% to 20%

• Assessment of Obesity:

BMI

Skinfold Thickness

Waist Circumference & WHR

Others (Total body Water

Total body Potassium

Body density

Measuring fat cells)


OBESITY (CONTD..)

• Complications of Being an Obese:

• Hypertension

• Dyslipidemia

• Glucose intolerance

• Coronary heart disease

• Arthritis

• Breast, colon carcinoma

• Gall stone diseases

• Depression and Withdrawal into self


DIABETES

• Around 150 million Diabetic World-wide. Predicted to DOUBLE by 2025.

• 20% of them in SEAR.

• Screening Methods:

Venous Blood Sugar testing

Random

Fasting

Post-prandial Urine Glucose Examination


ACCIDENTS AND INJURIES

• What is Accident?

-Unpremeditated event resulting in recognizable damage.

• A significant cause of morbidity, mortality, disability among the productive age group population of a country.

• Etiological factors:

Irresponsible usage of machines

Risk-taking behavior

Weak legislation


ACCIDENTS AND INJURIES (CONTD..) Driving vehicles under influence of alcohol

Poor maintenance of machines/vehicles

Over-crowding, poor illumination, inadequate layout in the road

Low driving standards

Not using protective measures

Lack of concentration while operating machines/vehicles.


MALIGNANCIES• An important cause of mortality, disability world-wide.

(10 million mew cases diagnosed/year, 6 million die of cancers/annum)

• 3 most common malignancies worldwide:

1. Lung cancer (12.3% of all cancers)

2. Breast cancer (10.4%)

3. Colorectal cancer (9.4%)

• Top 3 “killers” among the malignancies:

1. Ca Lung

2. Ca Stomach

3. Ca Liver

• Ca cervix most common cancer among the Indian woman


BLINDNESS

• WHO defines Blindness as:

“Visual Acuity of less than 3/60 (Snellen) or its equivalent in the better eye”.

• Low Vision:

Visual acuity poorer than 6/18 but better than 3/60.

• In India 0.7% people are blind. Among them, 62.6% are due to Cataract.


BLINDNESS (CONTD..)

• Other important causes (in decreasing order of prevalence):

1. Refractive error

2. Glaucoma

3. Posterior segmental pathology

4. Corneal opacity

5. Miscellaneous

• Vision 2020: “Right to sight”


PSYCHIATRIC DISORDERS

• With the ever-increasing stress in today’s day-to-day life, psychiatric disorders are assuming more significant dimension.

• Prevalent almost in all age-groups.

• Increased life expectancy

More population reside in the elderly group

Hence problems of poor mentation (Alzheimer’s, Dementia, Insomnia, Irritability etc.) warrant special attention.


OTHER NCDS AMONG ELDERLY

• Arthritis

• Osteoporosis

• Chronic Respiratory Diseases (e.g. Chronic Bronchitis, Emphysema, Asthma)

• Renal Failure

• Chronic liver diseases

• Hearing Impairment


PREVENTION OF NCDS

Prevention

Primary Secondary Tertiary

Prevention Prevention Prevention

Population High Risk

Strategy Strategy


EXERCISE RECOMMENDATION FOR WEIGHT CONTROL• 4 to 5 sessions per week,

• MET level 5 to 8 (moderate intensity exercises )

• 45 to 60 minutes/session.


OTHER ACTIVITIES AND MET LEVELS


JUST A MOMENT…..

“….The Japanese smoke a lot and suffer fewer heart attacks than Australians or New Zealanders;

The French eat a lot of fat and suffer fewer heart attacks than Australians or New Zealanders;

The Italians drink a lot of wine and also suffer

fewer heart attacks than Australians or New Zealanders…..”

(Conclusion : NEVER COPY OTHERS’ BAD HABITS BLINDLY; DIFFERENT POPULATION HAS DIFFERENT LEVEL OF SUSCEPTIBILITY !!!!!!!!)


BIBLIOGRAPHY

• Text book of Preventive and Social Medicine-PARK.

• AFMC Textbook of Community Medicine.


THANK YOU

That’s It …

Education

Non communicable diseases - dr. anindya