Tropenklinik, Tuebingen-Germany

EPN FORUM 2016

Plenary 2

General Overview of epidemiology and priority Non-Communicable

Diseases (NCDs) in Church Health Institutions (CHIs)

MBChB, MSc Clinical Epidemiology

Chidzewere Nzou

Programme Manager Zimbabwe Association of Church related Hospitals (ZACH)Email: nzou@zach.org.zw

Presentation Outline…

1. Definition of Non-Communicable Disease (NCD) 2. Approaches: Medicine vs Epidemiology

3. Risk factors and priority NCDs in CHIs

4. Global NCDs burden and measurements

Definition of Non-

Communicable Disease (NCD)

PART ONE

A disease that has a prolonged course, that does not resolve spontaneously, and for which a complete cure is rarely achieved

(McKenna, et al, 1998)N.B Do not result from an (acute) infectious process and hence are ‘not communicable’

Extended Definition:

In some definitions, NCDs also include:• chronic mental diseases and

• injuries, which have an acute onset, but may be followed by prolonged

convalescence and impaired function.

Characteristics of NCDs

●Multiple risk factors●Complex etiology (causes)●Long latency period ●Non-contagious origin (non-communicable)●Prolonged course of illness●Functional impairment or disability●Incurability

Approaches: Medicine vs Epidemiology

PART TWO

Risk Factors and Priority NCDs in CHIs

PART THREE

Risk Factor “An aspect of personal behavior or

lifestyle, an environmental exposure, or an inborn or inherited characteristic that

is associated with an increased occurrence of disease or other health-

related event or condition”

Cardiovascular Major modifiable risk factors­ High blood pressure­ Abnormal blood lipids­ Tobacco use­ Physical inactivity­ Obesity­ Unhealthy diet (salt)­ Diabetes

Other modifiable risk factors­ Low socioeconomic status­ Mental ill health (depression)­ Psychosocial stress­ Heavy alcohol use­ Use of certain medication­ Lipoprotein(a)

Non-modifiable risk factors­ Age­ Heredity or family history­ Gender­ Ethnicity or race

“Novel” risk factors­ Excess homocysteine in blood­ Inflammatory markers (C-reactive

protein)­ Abnormal blood coagulation (elevated

blood levels of fibrinogen)

Diabetes Major modifiable Risk Factors- Unhealthy diets- Physical Inactivity- Obesity or Overweight- High Blood Pressure- High Cholesterol

Other Modifiable Risk Factors- Low socioeconomic status- Heavy alcohol use- Psychological stress- High consumption of sugar-

sweetened beverages- Low consumption of fiber

Non-modifiable Risk Factors- Increased age- Family history/genetics- Race- Distribution of fat

Other Risk Factors- Low birth weight- Presence of autoantibodies

Cancers

Cancer type Risk FactorsCervical Cancer • Human papilloma virus infection (HPV)

• Smoking• Immune Deficiencies• No access to PAP screening• Family history of cervical cancer

Lung Cancer • Smoking pipes or cigars now or in the past• Second-hand smoke• Radiation therapy to the breast or chest• Being exposed to 1) asbestos 2) radon 3) chromium 4)

nickel 5) arsenic 6) soot or 7) tar• Air pollution

Cancer type Risk FactorsBreast Cancer • Hormone therapies, Weight, physical activity, Genetics or

family history• Age is the most reliable risk factor

‒ Risk increases with age

Prostate Cancer • age , obesity, weight gain

Liver cancer • Chronic hepatitis infections and Cirrhosis• Diabetes• Heavy alcohol consumption• Obesity

Cancer type Risk FactorsColorectal cancer ‒ Aging and Black race

‒ Unhealthy diet and low exercise‒ Diabetes‒ Family history of colorectal cancer

Stomach Cancer • Smoking • Family history of stomach cancer• Helicobacter pylori infections and ulcers or polyps• Diet

‒ High salt foods ‒ smoked foods ‒ pickled foods

Cancer Pictures

Chronic respiratory diseases

Genes

Infections

Socio-economic status

Aging Populations

Priority NCDs and common Risk Factors

Global NCDs burden and

measurements

PART FOUR

Global Trends Causes of Deaths

0

5

10

15

20

25

30

2004 2015 2030 2004 2015 2030 2004 2015 2030

Dea

ths

(mill

ions

)

High income Middle income Low income

HIV, TB, malariaOther infectiousMat//peri/nutritional

CVD

Cancers

Other NCDs

Road traffic accidentsOther unintentionalIntentional injuries

27

Epidemiological Shift: A transition from predominance of infectious diseases to chronic, degenerative, or man-made diseases and relates

well to demographic shift

Global Health Observatory (GHO) http://www.who.int/gho/en/Provides data and analyses on global health priorities

• Noncommunicable diseases• Mortality/morbidity• Risk Factors• Country statistics and health data

Media centre fact sheets http://www.who.int/mediacentre/factsheets/en/

• Key facts• Symptoms• Risk factors• Burden of disease

Incidence Rate- The development of new cases of a disease that occur during a specified period of time in previously disease-free or condition-free (“at risk”) individuals per 100,000 people

Cumulative incidence- PROPORTION of individuals who become diseased during a specified period of time Range: 0 to 1.0

Prevalence- The number of existing cases divided by the population count. Measured at a point in time rather than over some intervalTypically shown as a percentageMortality/Crude mortality- Number of deaths in a given time or place

Measurements of disease burden

Years of life lost (YLL) Measures the years of life lost due to premature mortality

Years of life with disability (YLD)Measures years of healthy life lost due to living in states of less than full health

Disability-Adjusted Life Year (DALY)Represents the total number of years lost to illness, disability (health utility), or premature death within a given population

Quality-Adjusted Life Year (QALY)Gives us an idea of how many extra months or years of life of reasonable quality a person might gain as result of treatment

Example- DALYs

Example Mortality DALYS

%1. High blood pressure 12.82. Tobacco use 8.73. High blood glucose 5.84. Physical inactivity 5.55. Overweight and obesity 4.86. High cholesterol 4.57. Unsafe sex 4.08. Alcohol use 3.89. Childhood underweight 3.810. Indoor smoke from solid fuels 3.3

59 million total global deaths in 2004

%1. Childhood underweight 7.82. High blood pressure 7.53. Unsafe sex 6.64. Unsafe water, sanitation, hygiene 6.15. High blood glucose 4.96. Indoor smoke from solid fuels 4.87. Tobacco use 3.98. Physical inactivity 3.89. Suboptimal breastfeeding 3.710. High cholesterol 3.3

1.5 billion total global DALYs in 2004

THANK YOU!