non communicable diseases (final)

Prepared by:

SAgun PAudelHealth Assistant

Student of BPH @ LA GRANDEE International college, Simalchour

Pokhara, Nepal

Presented with:• Samjhana Gurung ‘A’• Samjhana Gurung ‘B’• Sabita Timilsina &• Sarala Kumal

A Term Paper Presentation to fulfill the partial requirement of BPH second semester [Basic Epidemiology 1st -TPP

3.1]

04/11/23 3prevalance of NCD's in Nepal

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


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.

2- Commission of Chronic Illness, USA.04/11/23 5prevalance of NCD's in Nepal

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.


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.


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.04/11/23 8prevalance of NCD's in Nepal

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 20044-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 20046- World Health Report 20057- 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)


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.


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 standardized, per 100,000 population)

DALY Rate (age standardized, per 100,000 population)

CVD 310 2,285

Cancers 120 1,186

Respiratory diseases 94.5 1,102Diabetes 30.8 322

All NCDs 795.9 13,467

Road Traffic Injuries 19.7 526

http://www.nphfoundation.org/

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 :


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 %.


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


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 %.


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.


Total number of In patient morbidity by communicable and non-communicable diseases :


Source: HMIS/MD, DoHS FY 2066-67

Communicable diseases


Communicable diseases

Non-Communicable diseases

Number of in patient

(42,683)14.28%


6,039) 12.00%

(264,327) 88.00%

Death Rate among Inpatient

0.57% Source: HMIS/MD, DoHS

1.20% 1.00%

04/11/23 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 only12 % 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



• 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.


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.


• . 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


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.04/11/23 32prevalance 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 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.


References:1. EURO sumposium, 1997

2. Commission of Chronic Illness, USA3. World Health Report 20044. Menzies Research Institute Tasmania. Non-communicable Diseases. [cited

2010 20 August]5. World Health Report 20046. World Health Report 20057. 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. KathmanduOther:•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

http://www.google.com/


http://www.nhrc.gov.np/

04/11/23 37धन्यवा�द Have a Nice Day……prevalance of NCD's in Nepal

non communicable diseases (final)

Health & Medicine