non-communicable diseases _final_

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non-communicable diseases _final_ Powered By Docstoc
					     Prepared by:
                                     Presented with:
   SAgun PAudel                     •   Samjhana Gurung ‘A’
         Health Assistant
 Student of BPH @ LA GRANDEE        •   Samjhana Gurung ‘B’
International college, Simalchour   •   Sabita Timilsina &
         Pokhara, Nepal
                                    •   Sarala Kumal
   A Term Paper Presentation to fulfill
 the partial requirement of BPH second
 semester [Basic Epidemiology 1st -TPP
                   3.1]




8/20/2012      prevalance of NCD's in Nepal   3
                            Introduction
Prevalance :
All current cases (old and new) of a disease existing at a
  given point at a time or over a period of time.


Non-communicable disease:
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.




  8/20/2012                      prevalance of NCD's in Nepal   5
2- Commission of Chronic Illness, USA.
 Have long latent period between the exposure and
  causes.
 Disability and fatality rate is high.
 Mostly irreversible.
 Are slow in onset and development and long term
  impact.
 They require a long term systemic approach to
  treatment.
 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
                 Risk factors:
The risk factors for many of these conditions are
   associated with environmental and genetic
   factors.
1. Major behavioural risk factors:
 Tobacco use (cigarette use and other forms of
       smoking)
      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
       cholesterol
3. Other risk factors
 Failure to obtain preventive services
 Environmental factors etc.
These risk factors have 80% contribution in the
  development of NCDs.
    8/20/2012              prevalance of NCD's in Nepal    8
                         Objective:
General Objectives:
• To find out the prevalence of non-communicable disease
in Nepal.
 Specific Objectives:
• To identify the prevalence of top non-communicable

diseases.
• 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.
        Methodology:

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-
income countries.4

3- World Health Report 2004
4-Menzies      Research   Institute   Tasmania.    Non-communicable    Diseases.  [cited   2010   20   August];   Available   from:
         http://www.menzies.utas.edu.au/information.php?Doo=ViewData&type=Disease&ID=40
• 75% of the total deaths due to NCDs occur in developing
  countries.5
• out of 58 million deaths from all,NCDs account for 35
  million deaths.6
• 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.




8/20/2012            prevalance of NCD's in Nepal    13
          Nepal:
Facts;
•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
effects.
•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)

Source: www.nphfoundation.org

                        Death Rate (age             DALY Rate (age
                        standardized, per 100,000   standardized, per 100,000
                        population)                 population)
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
    (RHD’s)
•   Diabetes
•   Mental disorders
•   cancers
•   Chronic respiratory disease
•   Obesity
•   Blindness
•   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
Investment, 2005’’

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
NCD’s.
   Facts and figures :




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                   Annual report 2065-66 :
   Communicable and Non-Communicable Cases among the
     total OPD Cases by National and Regions, FY 2065/66
                         (2008/2009)
                   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 %.




8/20/2012          prevalance of NCD's in Nepal   23
             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
  diseases.
• 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
                           DoHS                                    diseases


Number of     (42,683)     Source:                   6,039)        (264,327)
in patient    14.28%       HMIS/MD,                  12.00%         88.00%
                           DoHS

Death Rate    0.57%        Source:                   1.20%         1.00%
among                      HMIS/MD,
Inpatient                  DoHS



8/20/2012                   prevalance of NCD's in Nepal                          25
                    Description:
• 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
diseases.
• 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
communicable diseases.
                   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% .


Source: www.nphfoundation.org


  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
  physical activity.

8/20/2012           prevalance of NCD's in Nepal    28
            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.
 8/20/2012                prevalance of NCD's in Nepal   29
• . This approach is most pointedly expressed in
  following paragraph:
• "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
         Conclusion:
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.
        Recommendation:
• 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
    treatment facilities.
• 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
 8/20/2012                                                  32
• 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
  priority.
• 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
                       References:
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
Other:
•www.google.com
•Nepal Public Health Foundation (NPHF) (www.nphfoundation.org)
• www.nhrc.gov.np
•Prevalance of NCD’S in Nepal hospital based study. Conducted by NHRC.
• Annual Report 2064-65 & 66-67
8/20/2012    धन्यवाद
            prevalance of NCD's in Nepal   Have a Nice Day……
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