ALLIED HEALTH SCIENCES Basic Community Health

Non-Communicable diseases
Dr. N Sivarajah Department of Community Medicine Faculty of medicine, University of Jaffna September 06, 2012

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Diseases classified as
Communicable diseases: Spreads from one person to other
Typhoid, Cholera, Plague, Rabies,

Non Communicable diseases: Does not spread. Has a risk factor

CVD (Heart attack, Hypertension,Stroke), Diabetes, Cancers, Mental illness, Accidents

Dr. N Sivarajah

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What are Non-Communicable diseases (NCD)

No clear definition Includes
Cardiovascular diseases Cancer Diabetes Obesity Renal diseases Mental diseases nervous system diseases Musculo-skeletal diseases Respiratory system (Chronic bronchitis, emphysema, asthma))

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Why is NCD becoming important?

Assuming importance in developed and less developed countries Contributed by increased life expectancy Life-style and behavior changes Modern medical knowledge is enabling people with NCD to survive longer

Dr. N Sivarajah

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Risk factors in NCD

Smoking Alcohol abuse Non availability of early screening procedures Life style changes Environmental
Occupational hazards Water and air pollution Destructive weapons

Stress factors
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Difficulties in investigation, Prevention and Research

Absence of known agent
Except in few instances like asbestosis, silicosis etc

Multi-factorial causation
No single cause. Usually several risk factors are identified and they have a cumulative effect.

Long period between exposure to risk factors and development of disease Indefinite onset

Dr. N Sivarajah

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Prevention of NCD
Involves complex mix of interventions because the causation is multi-factorial. Health promotion is a means of primary prevention In late identification, available prevention will be tertiary prevention.

Dr. N Sivarajah

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Services needed for Chronic NCD patients

Early Screening facilities Improved methods of diagnosis, treatment and Rehabilitation. Measures to control air, food and water pollution Reducing accidents Intensive health education to change behavior and lifestyles
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Upgrading standards of institutional care Improved PHC Political commitment to control

Smoking Alcohol abuse Drug abuse

Holistic approach considered in relation to family and community.

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Coronary Heart Disease

Impairment of heart function due to inadequate blood flow to the heart compared to the needs, caused by obstructive changes in the coronary circulation to the heart Has developed epidemic proportions.

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CHD could manifest as

Angina on effort Myocardial infarction Irregularities of the heart Cardiac failure Sudden death

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Risk factors
Non-modifiable factors Age Sex Family History Genetic factors Personality ?
Type A behavior

Modifiable factors Smoking High Blood pressure Elevated serum Cholesterol Diabetes Obesity Sedentary habits Stress
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Prevention strategies
[Suggested by WHO Expert committee on prevention of CHD]

Population strategy
Prevention in whole populations Primordial prevention in whole populations

High risk strategy

Secondary prevention
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Population strategy
Dietary changes
Fat intake to be 20-30% of total energy intake Saturated fat intake to be less than 10% of total of total energy intake Dietary cholesterol to be below 100mg per 1000 kcals. per day. Increase complex carbohydrate consumption (eg. Vegetable, fruits,whole grains, & legumes) Avoid alcohol and reduce salt to <5g per day
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Population strategy (contd)

Smoking
Achieve a smoke-free society through
Education Legislation Fiscal measures Smoking cessation programmes

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Population strategy (contd)

Blood pressure Reduction of mean population blood pressure by
Reduced salt intake Avoidance of high alcohol intake Regular physical activity Weight control

Physical activity
Involvement of children in physical activities and exercise
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Primordial Prevention
Involves prevention of emergence & spread of CHD risk factors and life styles before appearance Attempts should be made to maintain traditional diet habits where they are advantageous.

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High Risk Strategy

Identifying risks by
Simple methods eg. BP , Blood cholesterol checks

Specific advice to those at risk Disadvantage Disease occurring among those apparently not at risk are excluded

Dr. N Sivarajah

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Secondary Prevention
Continuation of primary prevention Prevent recurrence & progression of CHD Involves
Cessation of smoking Control of hypertension Effective drug therapy

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References
K Park. (2002). 17th ed. Parks text book of Preventive and Social medicine. m/s Banarsidas Jabalpur India. pp 273-303

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