SAgun PAudel • Samjhana Gurung ‘A’
Student of BPH @ LA GRANDEE • Samjhana Gurung ‘B’
International college, Simalchour • Sabita Timilsina &
• Sarala Kumal
A Term Paper Presentation to fulfill
the partial requirement of BPH second
semester [Basic Epidemiology 1st -TPP
8/20/2012 prevalance of NCD's in Nepal 3
All current cases (old and new) of a disease existing at a
given point at a time or over a period of time.
Impairment of bodily structure or functions that necessitates
a modification of the patient’s normal life and has
persisted over extended life period of time.1
1– EURO sumposium, 1997
8/20/2012 prevalance of NCD's in Nepal 4
Charasteristics of NCD’S :2
NCD’s or chronic diseases are impairment or deviation
from normal with these characteristics;
• Are permanent
• Leave residual disability
• Caused by non- reversible pathological alteration
• Require special training of the patient rehabilitation
• Requires long period of observations.
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2- Commission of Chronic Illness, USA.
Have long latent period between the exposure and
Disability and fatality rate is high.
Are slow in onset and development and long term
They require a long term systemic approach to
Most chronic diseases are the result of multiple causes.
NCDs have emerged as the major causes of morbidity
and mortality worldwide.
8/20/2012 prevalance of NCD's in Nepal 6
The risk factors for many of these conditions are
associated with environmental and genetic
1. Major behavioural risk factors:
Tobacco use (cigarette use and other forms of
Harmful alcohol consumption
Unhealthy diet(low fruit and vegetale consumption)
physical in activity
Stress factors etc.
8/20/2012 prevalance of NCD's in Nepal 7
2. Major biological risk factors:
Overweight and obesity
Raised blood pressure
Raised blood glucose
Abnormal blood lipids and its subset raised total
3. Other risk factors
Failure to obtain preventive services
Environmental factors etc.
These risk factors have 80% contribution in the
development of NCDs.
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• To find out the prevalence of non-communicable disease
• To identify the prevalence of top non-communicable
• To compare the prevalance of patients in different
Developmental area of Nepal.
•To compare the prevalence of NCD’s in different years.
• To compare the prevalence of communicable diseases
and non-communicable diseases.
• To analyze the risk groups and factors of NCD’S in Nepal.
• To find out the NCD Policy and Strategies of GoN.
Data Type : Secondary data.
Finding and Discussion :
1. Global scenario :
• NCDs account for almost 60% of deaths and 47% of the
global burden of disease.3
•Today, non-communicable diseases, mainly cardiovascular
diseases, cancers, chronic respiratory diseases and
diabetes represent a leading threat to human health and
development. These four diseases are the world’s biggest
killers, causing an estimated 35 million deaths each year -
60% of all deaths globally - with 80%in low- and middle-
3- World Health Report 2004
4-Menzies Research Institute Tasmania. Non-communicable Diseases. [cited 2010 20 August]; Available from:
• 75% of the total deaths due to NCDs occur in developing
• out of 58 million deaths from all,NCDs account for 35
• Estimated that in 2020, the no. of deaths caused by
NCD’s in developing countries will equal the death
caused by communicable diseases.
• By 2020,chronic heart disease are expected to account
for7 of 10 deaths in world.7
5- World Health Report 2004
6- World Health Report 2005
7- Habib SH, Soma S. Burden of non communicable disease: Global overview. Health Economics Unit, Diabetic Association of Bangaladesh, 122 Kazi Nazrul Islam
Avenue, Dhaka 1000, Bangaladesh (available online April 1, 2010)
8/20/2012 prevalance of NCD's in Nepal 12
South-east Asian countries:
• World Health Organization (WHO) estimates about
54% of deaths and 44% of morbidity is attributed to
NCDs in this region.
• In Nepal, NCDs accounts for 42% of all deaths and is
projected to cause 66.3% of all deaths by 2030.
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•Nepal, one of the poorest countries in the world - at
136th position of human development index has grossly
limited treatment options for NCDs and their end organ
•Nepal is one of the developing countries of the world. It is
facing double burden of diseases with an added burden of
NCDs. Many researches on NCDs were conducted in Nepal
but magnitude of NCDS is still unknown.
Death and DALY rates of the NCDs in Nepal (by, 2002)
Death Rate (age DALY Rate (age
standardized, per 100,000 standardized, per 100,000
CVD 310 2,285
Cancers 120 1,186
Respiratory diseases 94.5 1,102
Diabetes 30.8 322
All NCDs 795.9 13,467
Road Traffic Injuries 19.7 526
Some prevalent NCDS in Nepal :
• Cardiovascular diseases such as; Ischaemic heart
disease(IHD),Hypertension, Rheumatic heart disease
• Mental disorders
• Chronic respiratory disease
• Hearing impairment
• Oral health and other chronic diseases
• Accidents and injuries etc.
Status of NCD’s in Nepal8
According to the WHO Global Report " Preventing Chronic Disease: A Vital
42% of total deaths are caused by NCD, of which;
CVD holds the top most position with 21% of all deaths,
followed by cancer (7%),
Chronic respiratory disease (5%),
and Diabetes (2%).
Road traffic injuries account for 9% of all deaths,
other chronic disease and rest of the chronic diseases being 7%.
• This composition is similar to Regional scenario. WHO global info base provides
a projection for the year 2030, which suggest a 66.2% increase in deaths caused
by CVD and 71.4% by Cancer.
8-Non-communicable Diseases: Emerging Trends and Socio-economic impact ,Dr. Mahesh Maskey MBBS, MPH, DSc. ,Executive Chair, Nepal Public
Health Foundation,17 Sept, 2010.
According to Annual report of MOHP in Nepal (2006),
In government hospital 81.5% outpatient and 88% of
in-patient attendance is due to morbidity related to
Facts and figures :
8/20/2012 prevalance of NCD's in Nepal 19
Annual report 2065-66 :
Communicable and Non-Communicable Cases among the
total OPD Cases by National and Regions, FY 2065/66
Source: HMIS/MD, DoHS
Level Communicable Non communicable
Eastern 889,918 3,556,605
Central 1,037,141 4,240,881
Western 718,054 3,515,735
Mid Western 697,014 388,314
Far Western 386,611 1,517,650
National 3,728,738 15,219,185
From data :
The communicable and non-communicable cases at the
National level. Of the total OPD new visits more than
80.0 % of the total patients have visited for non
communicable diseases where as patients visiting for
communicable diseases represent only less than 20.0
8/20/2012 prevalance of NCD's in Nepal 21
Annual report 2066-67 :
Communicable and Non-Communicable Cases among the total OPD Cases
by National and Regions, FY 2066/67 (2009/2010)
Source: HMIS/MD, DoHS
Level Communicable Non communicable
Eastern 968,735 3,917,213
Central 1,015,132 4,660,491
Western 625,523 4,059,816
Mid Western 760,996 2,648,755
Far Western 431,843 1,805,614
National 3,802,229 17,091,889
8/20/2012 prevalance of NCD's in Nepal 22
From this data:
The communicable and non-communicable
cases at the National level. Of the total OPD
new visits more than 81 % of the total patients
have visited for non communicable diseases
where as patients visiting for communicable
diseases represent only less than 19.0 %.
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Comparative study :
• In 2065-66, 80% of OPD patients are suffered from
NCD’S and in 2066-67, there is increase in the % of
patients by 1%.
• Similarly the no. of patient who suffered from NCD’S is
increased rapidly in compare with communicable
• In every developmental region there is high number of
OPD patient suffered from NCD’S.
8/20/2012 prevalance of NCD's in Nepal 24
Total number of In patient morbidity by communicable
and non-communicable diseases :
Source: HMIS/MD, DoHS
Source: HMIS/MD, DoHS FY 2066-67
Communicable Source: Communicabl Non-
diseases HMIS/MD, e diseases Communicable
Number of (42,683) Source: 6,039) (264,327)
in patient 14.28% HMIS/MD, 12.00% 88.00%
Death Rate 0.57% Source: 1.20% 1.00%
8/20/2012 prevalance of NCD's in Nepal 25
• In FY 2065-66: 86 % of the in patients were admitted for
non-communicable diseases where as only 14 % of the
discharged patients were admitted for the communicable
• Similarly in FY 2067-68 : 88 % of the in patients were
admitted for non-communicable diseases where as only
12 % of the discharged patients were admitted for the
NCD Risk Factors:
• Several surveys have been conducted to measure the
NCD risk factors in Nepal. All these survey show high
prevalence of risk factors.
• According the national survey of 2008, among the four
major risk factors current tobacco use (both smoke and
smokeless) was 37%. Regarding alcohol consumption
current consumers were 28.5% .
8/20/2012 prevalance of NCD's in Nepal 27
• Among the daily drinkers ,One in three men and one
in ten women were drinking harmful amount of
alcohol (>60 gms of alcohol).
• More than five serving of fruits and vegetables were
recommended for healthy living. However, the
survey shows that 60.5% women are
currently consuming less than 5 serving of fruit and
vegetable daily in Nepal.
• And almost 95% of surveyed population was found
to be engaged in either moderate or high level of
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NCD’s Policy and Strategies of Nepal 9 :
• Regional Framework of WHO SEARO provides
a comprehensive and stepwise approach to prepare
the national policy, strategy and build capacity for
prevention and control of NCD.
• In Nepal a draft of "National policy, strategy and plan of
action for prevention and control of non-
communicable disease" has been prepared by MOHP .
• This document was prepared in the year 2009 but has
not been endorsed by the government as yet. Though
there are enough room for improvisation,
nonetheless, this document correctly advocates for a
comprehensive and integrated approach in reducing
the burden of disease in Nepal.
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• . This approach is most pointedly expressed in
• "Primary prevention of NCD is the most cost effective
method to tackle the growing epidemics of NCDs.
Secondary and tertiary prevention incur huge cost in
one hand and the facilities to carry out secondary and
tertiary prevention is unlikely to be available every
where in Nepal in near future. The only resort that
Nepal can afford is to go for primary prevention and is
feasible if integrated approach is adopted’’
9- MOHP, (2009) "Nepal National Policy, Strategy and Plan of Action " for Prevention and Control of
Non-Communicable Diseases" (draft), Government of Nepal. Kathmandu
8/20/2012 prevalance of NCD's in Nepal 30
In conclusion, the magnitude of non communicable
disease is substantial in Nepal and is regarded as a public
health problem. The governmental, non-governmental and
community based organizations are still fighting to tackle
the burden of infectious diseases. Unless urgent and
specific focus on preventing, treating and control of NCDs
are targeted, the burden of the NCDs will be unbearable to
the poor nation like Nepal.
• Prevention of NCDs requires an integrated action
across a range of sectors at local, regional and national
levels. Each individual sector can perform a specific role
to contribute from their level. Health care and public
health must play a fundamental role in providing care
and support for the patients but also in applying the
unique public health models to prevent the associated
risk of NCDs.
• Infrastructure of hospital for NCDs and Diagnostic and
• Physicians and health workers should be routinely
trained and re-trained on the prevention and control
measures of NCDs. prevalance of NCD's in Nepal
• There should be provision of supply of low cost drugs
to the diabetic patients by the Government of Nepal.
• Preventive part of non communicable disease should be
emphasized and given high priority in treating NCDs.
• Health promotional activities using media should be of
• Most of the health institutions do not have separate
unit for NCDs where a patient could receive a quality
treatment. There should have separate unit for NCDs
patients at least at the tertiary level health facilities.
8/20/2012 prevalance of NCD's in Nepal 33
1. EURO sumposium, 1997
2. Commission of Chronic Illness, USA
3. World Health Report 2004
4. Menzies Research Institute Tasmania. Non-communicable Diseases. [cited
2010 20 August]
5. World Health Report 2004
6. World Health Report 2005
7. Habib SH, Soma S. Burden of non communicable disease: Global overview.
Health Economics Unit, Diabetic Association of Bangaladesh, 122 Kazi Nazrul
Islam Avenue, Dhaka 1000, Bangaladesh (available online April 1, 2010)
8) Non-communicable Diseases: Emerging Trends and Socio-economic impact
,Dr. Mahesh Maskey MBBS, MPH, DSc. ,Executive Chair, Nepal Public Health
Foundation,17 Sept, 2010.
9) MOHP, (2009) "Nepal National Policy, Strategy and Plan of Action " for
Prevention and Control of Non-Communicable Diseases" (draft), Government
of Nepal. Kathmandu
•Nepal Public Health Foundation (NPHF) (www.nphfoundation.org)
•Prevalance of NCD’S in Nepal hospital based study. Conducted by NHRC.
• Annual Report 2064-65 & 66-67
prevalance of NCD's in Nepal Have a Nice Day……