In the Name of ALLAH, In the Name of ALLAH, Ever Ever Beneficent, Infinitely Beneficent, Infinitely MercifulMerciful

Non Communicable Non Communicable Diseases In Diseases In Developing Developing CountriesCountries

Burden of NCDs

Health transition in developing countries

Impact of NCDs on public health

Trends in Developing Countries

0

10

20

30

40

1990 2000 2010 2020

Dea

ths

(mill

ions

)

NCDs Comm. Dis. Injuries

Current & Projected Burden of Diseases China India Rest of Asia

(Murray & Lopez, 1990)

Burden of NCDs in Burden of NCDs in PakistanPakistan

Causes of Burden of Disease (DALYs) Percentage (%)

Communicable Disease 38.4

Non-Communicable Disease 37.7

Causes of Deaths Year (1992) Year (2003)

Communicable Disease 49.8 26.2

Non-Communicable Disease 34.1 54.9

The world bank. Pakistan towards a health sector strategy. Washington, USA: health Nutrition and population unit, South Asia region, the world bank: 1998Government of Pakistan. Respective surveys for the years 1992-2003. federal bureau of statistics; Pakistan demographic surveys. Islamabad, Pakistan: statistics division.

2002 Disease or Injury

Burden of NCDs on DALYs

NCDs – 5 out of 121.Ischaemic heart disease2.Cerebrovascular disease5.Chronic obstructive pulmonary disease9.Trachea and Lung Cancers11.Diabetes mellitus

2030 Disease or Injury

NCDs – 7 out of 121.Ischaemic heart disease2.Cerebrovascular disease4.Chronic obstructive pulmonary disease 6.Trachea and Lung Cancers7.Diabetes mellitus 10.Stomach Cancer11.Hypertensive heart diseases

Global diabetes epidemic

International Diabetes Federation

Est

imat

ed n

um

ber

of

peo

ple

wit

hd

iab

etes

wo

rld

wid

e (m

illi

on

s)

Year

30

150

246

380

050

100150200250300350400

1980 1990 2000 2010 2020 2030

Diabetes: Developed vs Developing

Region 2000 2025

Developed countries

6.2%

54.8 million

7.6%

72.2 million

Developing countries

3.5%

99.6 million

4.9%

227.7 million

King et al, Diabetes Care 1998; 21: 1414-31

Hypertension 40-50% Hyperlipidemia 30-35% Central Obesity 46-53% Diabetes 07-12% 7.0 million have diabetes

14.5 million will have diabetes by 2025

Burden of Diabetes in Pakistan

1-Pakistan medical research council. National health survey of Pakistan – health profile of the people of Pakistan. Islamabad, Pakistan: Federal bureau of statistics and Pakistan medical research council;2- Data from M Phil June 2007, “Metabolic Syndrome and Insulin Resistance in Pakistan: a population based study in adults 25 years and above in Karachi, University of Oslo3-Jafer TH, et al. Heart disease Epidemic in Pakistan: Women and Men at Equal Risk. Am Heart J 2005;150:221-64-Heart file. Population-based surveillance o Non- communicable disease 1st round, 2005. Islamabad, Pakistan: heart file, ministry of health and world health organization; 20065.Prevalence of diabetes in Pakistan.  Diabetes Research and Clinical Practice, Volume 76, Issue 2, May 2007, Pages 219-222 A. Shera, F. Jawad, A. Maqsood

Burden of NCDs

Health transition in developing countries

Impact of NCDs on public health

0

10

20

30

40

50

60

70

80

1950 1960 1970 1980 1990

(Age

in y

ears

) World

LessDeveloped

MoreDeveloped

Rising Life Expectancy

WHO report, 1997

Non-communicable diseases/diabetes in developing countries

Health Transition

Health Transition: demographic transition and epidemiologic

transitionEconomic, social & environ mental changes

public sanitation, housing, health care

nutrition technology for health care

mortality( infant mortality) life expectancy fertility

Increasing aging population

persons at risk of developing NCDs

levels of RF:fat, calories, tobacco & sedentary habits

Industrialization & urbanization

NCD infectious

diseases

per cap. income, wealth

Burden of NCDs

Health transition in developing countries

Impact of NCDs on public health

Impact of NCDs on public health in DCs

High and rising burden upon productive middle age persons

Negative micro-economic impactHealth of household, indirect impact on children`s

care costs

Negative macro-economic impactShort term impact on costs, long term impact on

production, long term cost escalation

Issue of efficiency in allocation of resourcesCurative and prevention interventions

60% of deaths worldwide 43% of the disease burden

By 2020 73% of deaths worldwide 60% of the disease burden

Global burden of NCDs on DCs

50% deaths due to CVDs.

There are more CVD deaths in India or China than in all developed countries added together.

Economic Impact of NCDs

http://www.idf.org/webdata/docs/background_dis_final.pdf Press Release: Karachi, Pakistan-26 February 2006

In 2005 alone, Pakistan lost 1 billion dollars in

national income from premature deaths due to heart

disease, stroke & diabetes and will lose 31 billion

dollars over next ten years if the solutions are not

implemented

NCDs in developing & developed countries. Are they same?

The compressed time frame of transition in developing countries imposes a large, double burden of

communicable and non-communicable diseases.

Impact of NCDs on Developing Countries

Prevention in developed countries epidemic had peaked and accelerated towards a

downswing in the developing countries efforts starting when the epidemic is on the

upswing.

NCD’s are to a great extent preventable

Simple changes in these lifestyles can prevent chronic diseases and promote health.

The health transition in developing countries: possible responses ?

Demographic (populations get older) Not modifiable

Lifestyle-epidemiologic (age-specific risk factor rates change) Modifiable

Socio-economic (differential risk factors levels across SES) Modifiable

Health services (access/use of preventive & curative services) Modifiable

Strategies to prevent the

emergence of NCDs

Strategies to prevent the emergence of NCDs

Population strategy• Public health approach• Targets population

High risk strategy• Clinical management• Targets individuals

Primary prevention(limit the number of new cases)

Preventing NCDS in developing countries: a window of opportunity

Focus on primary prevention with health policies Target high risk strategies (hypertension, diabetes)

National programs aimed at primary and secondary prevention and educational campaigns to be implemented.

Setting an agenda for action – The example of Pakistan

Identify and apply low cost and affordable interventions for case management

Set surveillance systems (particularly risk factors)

National diabetes plans1996 – 981999 – 012001 – 04

Made recommendations for prevention, management and surveillance

Setting an agenda for action – The example of Pakistan

Setting an agenda for action – The

example of Pakistan

Need to strengthen capacity building, leadership, partnership

2003 – National diabetes plan was incorporated into

the National Action Plan for NCDs (NAP-NCDs) MOH, DAP-WHO, Heartfile

Nishtar & Shera Pract Diab Int. Oct 2006;23:332-34

Preventive Strategies

Diet & Education

Public Awareness

Diabetes Educators Course

Foot Clinic

Diploma in Diabetology for Family Physicians

8 Batches completed 151 Diploma holders

Peripheral DiabetesCenters

National Health Network for Diabetes Control and Prevention

IT HCMSWebsiteNetwork

MulticenteredData base

Research & Audit PapersPresentations

National multicentered data

Future

Podiatry Course

National Foot Program

BIDE-DAP-UIO Collaborative Research Study :Diabetes Prevention Trials for high-risk subjects in Low Resource Environment

Diabetic Association of Pakistan &WHO Collaborating Centre

Baqai Institute of Diabetology and Endocrinology

University of Oslo, Norway

Prof. A. Samad Shera

Prof. Abdul Basit

Prof. Akhter Hussain

Study on impact of intervention for the prevention of Type 2 diabetes: (a randomized high-risk population based study in Pakistan and Bangladesh)

Funded by : University of Oslo, Norway

WDF – BIDE PROJECT

Integrated Masters Programs (M.Phil.) in Public Health Research in Asia (Bangladesh-Nepal,Bhutan, India and Pakistan) NOMA Project: (2007-2010) Diabetic Association of Bangladesh (DAB)

Bangladesh Institute of Research and Rehabilitation in

Diabetes, Endocrine and Metabolic Disorders (BIRDEM)

Bangladesh Institute of Health Sciences (BIHS)

Baqai Institute of Diabetology & Endocrinology, Baqai Medical University (BMU), Karachi, Pakistan

Diabetic Association of Nepal together with Kathmandu

University and Ministry of health-Bhutan.

Inst. of General Practice and Community Medicine,

Department of International Health, University of Oslo (UIO)

Funded by : Norwegian Research Council

Junior Doctors

Dr. Saheer

Dr. Aziz

Dr Shirjeel

Dietician

Ms Mahwish Ryaz

Mrs Safiya

Educationist

Dr.Asna

Dr Nausheen

Mrs. Rabia A. Rahman

IT Department

Mr. Mansoor Ahmed Siddiqui

Mr. Moneeb Ghouri

Mr Arif

Research Department

Dr. Rubina Hakeem

Dr. Zafar Iqbal Hydrie

Dr. Asher Fawwad

Mr. Bilal Tahir

Consultant Diabetologist

Dr Abdul Basit

Dr. Yakoob Ahmedani

Dr. Zahid Miyan

Dr.Asim Bin Zafar

Dr Ahmed Salman

Diabetes Foot Department

Dr. Syed Mansoor Ali

Dr. Farooq Chohan

Mr. Farrukh Muslim

Mr. Mumtaz

Mr. Aamir

Administration

Mr Zubair Kamal

Mr Abdul Rehman

BIDE-DAP-UIO Project

Dr. Zafar Iqbal Hydrie

Dr. Fareeha Faisal

Ms. Durashwar

Ms Zara Siddiqui

Mr M Yasin Kaleem Khan

Mr. Faraz Ul Islam

BIDE-WDF Project

Dr. M Zafar Iqbal Abbasi

Dr. Azmat

Dr. Aqil

Ms Hira