Konferans Lasante Primer

Lasante Pour Nou Tou, Partou, Par Nou Tou

Dr Jude Gedeon - PHC

Double burden of diseases

What are they?What are the Primary Health care

approach that works?

2

What constitute this double burden?Non Communicable and communicable Diseases• Morbidity and Mortality• Social Impact and well being• Economic impact• Productivity

Both NCDs and CDs have:• Modifiable and non modifiable risk factors• Take life from years and years from life• Require strong primary community based

interventions 3

4

HIV, TB, malaria

Other infectious

Mat//peri/nutritional

CVD

Cancers

Other NCD

Road traffic accidentsOther unintentionalIntentional injuries

0

5

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15

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25

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2004 2015 2030 2004 2015 2030 2004 2015 2030

Deat

hs (m

illio

ns)

High-incomecountries

Middle-incomecountries

Low-incomecountries

Global mortality projections, 2004 to 2030

Global Burden of Disease - WHO 5

Causes of deathThe five leading cause of death are:• Diseases of the circulatory system (32%);• Cancer (19%);• Diseases of the respiratory system (17%);• External causes of mortality (6%);• Infectious and parasitic diseases (6%).

Among cancer deaths, breast cancer in women andprostate cancer in men were more common.

What is driving the NCD burden?

We know the main risk factors for CVD/NCDs (This underlies rationale for prevention strategies)

Non-modifiable RF:• age, sex, family history

Behavioral RF (modifiable):• Smoking*• Unhealthy diet

(salt, sat. fat, lack fruit&veg)• Sedentary lifestyle

Endpoints:• Isch. heart disease• Stroke• Vascular disease• Heart failure• Some cancers• Respirat. diseases

Early life characteristics

Physiological RF:• Hypertension*• High cholesterol*• Diabetes*• Obesity

Socio-economic & cultural determinants

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BEHAVIOUR!

Daily consumption of sugary drinks among students aged 13-15Global School Based Student Health Survey (GSHS), 2015

• 2540 randomly selected students aged 11-16 in all schools examined in 2015

• Standard self-administered questionnaire

12 6 6 10 5 7

28

22 20 1513 13

23

24 2330

28 25

13

1819

2125 25

812 12

10 14 16

11 13 17 11 11 10

0%

20%

40%

60%

80%

100%

low

SES

mid

dle

SES

high

SES

low

SES

mid

dle

SES

high

SES

5+ times /day

4 times /day

3 times/day

2 times/day

1 time/day

< 1 time/day

No

Carbonated soft drinks Small packet fruit juice

Approximately 30% students drink 1 litre sugary drink /day = 30 tsp sugar = 120g = 460 kcalTherefore, given that 7000 Kcal = 1 kg fat, every month 2 kg of fat can be gained. 10

Less than a third of students are physically active > 60 min/day

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Summary findings from the GSHS-GYTS 2015

• 39% consumed fruit and vegetables regularly.

• Large majority consumed large amounts of soft drinks and/or manufactured

fruit juices

• 31% of students were not active at least 60 minutes during the past 7 days

• 20% of students smoked cigarettes on one or more days during the past 30 days

• 9% of students reported having used cannabis during the past 30 days

• 48% consumed alcohol during the past 30 days

• Half of students had sexual intercourse and 33% students had several partners

• 20% sexually abused, 10% by family members 12

Communicable disease burden

• Leptospirosis• HIV• Hepatitis• STIs• Dengue• Influenza-Severe Acute

Respiratory Infections• Antimicrobial resistance

infections• Gastroenteritis• HFNM disease• etc

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• Measles• Polio• Neglected tropical diseases• ZIKA• Drug resistance TB• Ebola• Marburg• RVF• etc

Re-emerging diseases

2018

• Cases of sexually transmitted infections reported by the CommunicableDiseases Control Unit was 806 (409 Males; 397 Females).

• Resistance to antibiotics is alarming for gonorrhoea:

• 51% of cases are resistant to Ciprofloxacin; 28% resistant to Ceftriaxone;21% resistant to Cefixime; and 7% resistant to all three antibiotics.

• Seychelles Hospital reported a total of 323 admissions with pneumonia with asignificant increase during the last quarter of 2018. Pneumonia was the primaryor contributing cause of death in 20.8% of all registered deaths in 2018compared to 16% in 2017.

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Dengue

Measles case distribution (AFR), 2015-2019

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1000012000140001600018000200002200024000260002800030000320003400036000380004000042000440004600048000

Month of onset

Num

ber o

f mea

sles

cas

es

UgandaOthersNigeriaNigerMadagascarLiberia

GhanaEthiopiaDR CongoChadCameroon

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Behaviour wins again

What is driving Communicable disease burden?

CDburden

NCDburden

MMG18

What are primary interventions that work?

Types of interventions for primary prevention of NCDs

1)Educational interventions• Media, school, workplace

2)Transportation policies (change environment)• Limit role of automobile (and increase use of buses): promote

walking/cycling• Health promoting districts / environments

3) Improve food supply (change environment)• Improve process and manufacturing (salt, trans fat, saturated

fats, etc)• Improving availability and reducing cost of healthy foods• Promoting healthy food choices and limiting marketing to

children 20

4) Economic policies: incentives and disincentives• Tax on tobacco• Differential taxes for energy dense foods vs fruits-

vegetables5) Initiatives at the community level

• Most effective when multifaceted, involving community• Dose of intervention and duration must be large

enough

6) Policy and legal environment

*Prevention*Reducing the

level of exposure to risk factors

*Management*Strengthen health care for people with NCDs

"Best buy" InterventionsRisk factor / disease

- Raise taxes on tobacco- Protect people from tobacco smoke- Warn about the dangers of tobacco- Enforce bans on tobacco advertising

Tobacco use

- Raise taxes on alcohol- Restrict access to retailed alcohol- Enforce bans on alcohol advertising

Harmful use of alcohol

- Reduce salt intake in food- Replace trans fat with polyunsaturated fat- Promote public awareness about diet and physical activity

Unhealthy diet andphysical inactivity

- Provide counselling and multi-drug therapy for people with medium-high risk of developing heart attacks and strokes

Cardiovascular diseaseand diabetes

- Hep B immunization to prevent liver cancer, treat Hep C- HPV vaccine- Screening and treatment of pre-cancerous- Cervix, prostate,

GI tract, breast

Cancer

“Best buys” for NCD prevention and control

UN General Assembly. Political declaration of the high-level meeting of the General Assembly on the prevention and control of non-communicable diseases. A/66/L.1. 16 September 2011. http://www.un.org/ga/search/view_doc.asp?symbol=A/66/L.1 22

Primary intervention for prevention of Communicable disease

• Basic Sanitation• Clean and safe water• Food safety-Farm to Fork• Vigilant community based surveillance and

engagement• Fast and accurate diagnosis and rapid response• Performing IDSR-Active engagement of key

stakeholders• Preventive programmes re-dynamising

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Vaccinate! The best tool against CD

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Creating the environment that protect and promote health, facilitates personal

choices and responsibility for better

health

25

Infectious diseases was said to be driven by poverty and poor access to health services.

Now, they are more and more becoming diseases of affluence, driven by poverty of the mind and often, over-misinformation

Final thought…

“Amidst the growing jungle of medical technological marvels, the basics of primary

prevention are too easily forgotten.”

Primary Health Care works!

40 years of evidence is shouting !!!

Thank you