Non-Communicable Diseases, and its status in Nepalpdf

About Non-communicable diseases, its present status in Nepal

1. Non-Communicable Diseases,
and its status in Nepal
Presented by;
Ramesh Bhatta (Associate Prof)
Principal, Yeti Health Science Academy

2. Introduction
•The term Noncommunicable diseases (NCDs) refer to a group of conditions
that are results of long-term health consequences and often create a need for
long-term treatment.
•
NCDs are also known as chronic diseases, tend to be of long duration and are the result of a combination of
genetic, physiological, environmental and
behavioral factors.
•The types of NCDs are cardiovascular diseases (such as heart attacks and
stroke), cancers, chronic respiratory diseases (such as chronic obstructive
pulmonary disease and asthma) and diabetes,mental health and neurological
conditions, chronic kidney disease, among many others.
•NCDs are not transmissible from person to person, these chronic conditions
require long term or lifelong care.
•An estimated 80% of NCDs are preventable. They are driven by modifiable risk factors including tobacco use, unhealthy diet, physical inactivity, harmful use of
alcohol, and air pollution.
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3. •Non-communicable diseases (NCDs) are emerging as the leading cause of
death(accounts for 74% of all deaths) and disability.
•It is rapidly increasing due to many social determinantslike unhealthy
lifestyles, globalization, trade and marketing, demographic and economic
transitions.
•The change in the status of these determinants has affected behavioral and
metabolic risk factorsof the general population.
•NCDs disproportionately impact on people living in low-and middle-
income countries, and are both a cause and a consequence of poverty and under development.
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4. •Mainly Cancer, cardiovascular diseases, chronic respiratory diseases and
diabetes are the number one cause of death and disability worldwide.
•NCDs could be largely prevented if action is taken to address their common risk
factors, and by keeping poorest and most vulnerable population at the center.
•Each year, 15 million people die from a NCD between the ages of 30 and 69
years; over 85% of these "premature" deaths occur in low-and middle-income
countries.
•Cardiovascular diseasesaccount for most NCD deaths, followed by cancers,
respiratory diseases, and diabetes.
•Detection, screening and treatment of NCDs, as well as palliative care, are key
components of the response to NCDs.
(Non Communicable Diseases,(23
rd
Dec, 2024) Available from:
https://www.who.int/news- room/fact-sheets/detail/noncommunicable-diseases)
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5. •To address the issues of NCDs initially WHO has focused on a ‘4x4’approach; that is,
•Four main NCDs: cardiovascular diseases (CVD), cancer, diabetes, and chronic respiratory
diseases and four main modifiable risk factors: tobaccoand alcohol use, unhealthy diet, and
physical inactivity.
•These four groups of diseases account for over 80% of all premature NCD deaths.
•In 2018, the third UN High- Level Meeting on NCDs included mental health and air
pollutionas core components of the NCD response, thereby introducing the ‘5x5’
approach.
•
5x5 Diseases
•Canceris a leading cause of chronic-disease related death in the world. About 10
million people die from cancer every year. At least one- third of cancers are
preventable, and many cases and deaths can be averted through prevention and
early detection.
•Cardiovascular disease (CVD)including heart attacks and stroke kills more people
globally than any other disease. About 18 million peoples die per year and one- third
of these deaths occurring before 70 years.
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6. •Diabetesis one of the world’s most common diseases. About 537 million
people are now living with diabetes globally, and is a leading cause of death.
Every year diabetic cases are increasing however access to treatment and care
is a major global health challenge. About 50% of people living with diabetes are
unable to access a regular supply of insulin that they need to survive.
•Chronic respiratory diseases, including asthma, are under-recognized, under-
diagnosed, under-treated and insufficiently prevented. Although breath is
fundamental to life, lung health is less well recognized as a critical health factor
than other indicators, such as weight and blood pressure.
•Mental healthis a state of wellbeing where people and societies function at
their best. A person’s ability to maintain good mental health is supported by
social, environmental, psychological, and biological factors.
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7. Conditions outside the 5x5
•Eye health conditionsinclude refractive error, cataracts, glaucoma, age-related macular
degeneration and other diseases that affect vision. The link between eye health conditions
and NCDs is complex, with the most common NCD eye health conditions often manifesting in
people living with NCDs, such as diabetes, and vice-versa.
•Oral health diseasesincluding tooth decay, tooth loss, and periodontal disease affect around
3.5 billion people globally, almost half of the world’s population. In fact, they are the most
common NCD. As oral diseases start to develop early in childhood, they are also an indicator of
socio-economic status in both children and adults.
•Obesityis a known risk- factor for many NCDs but is also increasingly considered a disease in
its own right. About 800 million people worldwide are living with obesity including 39 million children under the age of 5 years in 2020.
•Chronic kidney disease (CKD)is increasingly recognized as a global health priority. Kidney
failure is the most severe form of CKD and is the direct cause of over one million deaths each year. The prevalence and associated burden of CKD is rising worldwide; most of all in low-
income and middle-income countries.
•Thyroid conditionscan lead to serious health issues if not treated, due to the vital role that
thyroid hormones play in regulating heart and gastrointestinal function, brain development and function, physical development, and cellular metabolism.
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8. •However, most NCDs are preventable, with poor health
largely driven by five main modifiable risk factors:
•Tobacco use
•Unhealthy diets
•Physical inactivity
•Alcohol use and
•Air pollution
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9. People at risk
•People of all age groups, regions and countries are affected by NCDs. These
conditions are often associated with older age groups. Children, adults and the
elderly are all vulnerable to the risk factors contributing to NCDs, whether from
unhealthy diets, physical inactivity, exposure to tobacco smoke, or the harmful
use of alcohol or air pollution.
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10. Risk factors:
•Behavioral risk factors
Behavioral risk factors increase the risk of NCDS, including:
•tobacco use (including the effects of exposure to second-hand smoke);
•unhealthy diets, including excess salt, sugar, and fats;
•harmful use of alcohol;
•insufficient physical activity
•The social, commercial, and physical environment are key drivers of these behaviors.
•Metabolic risk factors
Behavioral risk factors contribute to four key metabolic changes that increase the risk
of NCDs:
•raised blood pressure (including hypertension);
•overweight/obesity;
•high blood glucose levels (including diabetes); and
•abnormal blood lipids (including high cholesterol).
•In terms of attributable deaths, the leading metabolic risk factor globally is elevated
blood pressurefollowed by raised blood glucose and overweightand obesity.
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11. •Environmental risk factors
Several environmental risk factors contribute to NCDs, e.g. Air pollution (indoor and
outdoor)
Prevention and control
For controlling NCDs, it is important to;
•Focus on reducing the risk factors associated with these diseases.It is also a low-cost
solution.
•Monitoring progress and trends of NCDs and their risk is important for guiding policy
and priorities.
•Comprehensive approach, requiring all sectors, including health, finance, transport,
education, agriculture, planning and others, to collaborate to reduce the risks associated with NCDs, and to promote interventions
to preventand control them.
•Timely management of NCDs by detecting, screening and treatingthese diseases, and
providing access to palliative carefor people in need.
•High impact essential NCD interventions can be delivered through a primary health care
approach to strengthen early detection and timely treatment.
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12. Major Risk Factors of NCDs
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13. Non-communicable diseases in Nepal
•Non-communicable diseases have remained as a major public health problem in Nepal. In
Nepal seven in ten death result from NCDs
•The premature mortality due to NCDs has risen from 51% in 2010 to 71% in 2019
•
Cardiovascular disease (CVDs) is responsible for 30% deaths, cancer 9%, diabetes 4%, chronic
respiratory diseases 10% and other NCDs 13%.
•Increasing life expectancy, demographic and epidemiological transition, rapid urbanization and
change in the lifestyle all contribute in rising burden of NCDs. The increasing disease burden is
associated with decreasing quality of life.
•Behaviors like tobacco use , harmful use of alcohol, intake of high proportion of unhealthy diet,
consuming less fruits and vegetables, high salt and trans-fat consumption, and physical
inactivity are the common modifiable risk factors of NCDs
•Risky behaviors are usually determined by social structures, economic disparities, and market
forces that entice the people into buying and consuming unhealthy products, ultra-processed
foods and drinks etc.
•Indoor air pollution is another important modifiable behavioral risk factor for the region and
the country.
•Overweight and obesity, raised blood pressure, raised blood glucose and abnormal blood lipids
are the metabolic risk factors.
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14. •The Package of Essential Non-communicable Diseases (PEN) has been introduced to screen ,
diagnose, treatand referCardio Vascular Diseases, COPD, cancer, diabetes, and mental health
at health posts, primary health care centresand district hospitalsfor early detection and
management of chronic diseases within the community.
•The Package of Essential NCDs (PEN) and HEARTS toolkit enhances fairness and effectiveness
in primary healthcare for limited-resource settings, identifying essential technologies,
medications, and risk prediction tools.
•[H= Healthy-lifestyle counselling, E=Evidence based protocols, A= Access to essential medicines and
technologies, R= Risk based CVD management, T= Team based care, S= Systems for monitoring]
•PEN is a cost-effective package for low-resource settings, strengthens health systems by
offering prioritized interventions, optimizing limited resources, and empowering primary care
through user-friendly tools
Objectives of PEN program
•To strengthen health systems to address the prevention and control of NCDs and underlying social determinants through people centered primary health care.
•To strengthen national and local capacity and partnership to accelerate country response for the prevention and control of NCDs.
•To reduce modifiable risk factors for non communicable diseases and underlying social determinants through creation of health- promoting environments.
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15. Health Facilities Services Basic Diagnostics
Health Post Detect hypertension, diabetes, assess
CVD risks, counselling, referral, follow-
up of low risk patients, refill drug, health
promotion.
Blood Pressure measurement device,
Glucometer, Urine Protein test strips,
urine ketone test strips, stethoscope,
,measurement tape, Digital weighing
scale, stadiometer, CVD risk charts
Primary Health Care Centers Confirm diagnosis of diabetes,
hypertension, manage, follow-up high
risk patients, refer complicated cases to
district hospital
Blood pressure measurement device,
Glucometer, Cardio Check, Urine protein
test strips, Urine ketone test strips,
stethoscope, CVD risk charts,
Measurement tape, digital weighing
scale stadiometer
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16. NCDs highlighted in National Health Policy, 2076
Individuals, families, societies and concerned agencies shall be made
responsible for prevention and control of non- communicable diseases and
integrated health system shall be developed and expanded.
•Programs to promote healthy life style shall be developed and extended
through health institutions of all levels.
•Multi-sectoral coordination with institutions related with drinking water,
environmental cleanliness, food security, educations and so on shall be
strengthened to promote health.
•Multi-sectoral partnership shall be implemented and necessary standards shall
be developed and implemented to reduce adverse effects and risk caused from enterprises and to make workplace secure and healthy.
•Proper system shall be developed to prevent and treat hereditary diseases.
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17. NCDs highlighted in National Health Policy, 2076………………………….
•Processed and readymade food items that are harmful to human health shall be
discouraged and use of hazardous chemicals, pesticides, adulteration during the
production, storage, processing and sales shall be controlled and regulated.
•Use of stimulating drugs and alcohol shall be discouraged through multi-
sectoral coordination and sales, spread and use of tobacco products shall be
effectively regulated.
•Promotional programs and structural arrangement shall be implemented to
prevent road accidents and other disasters.
•Coordination and advocacy with concerned stakeholders shall be done for
construction of cycle lane, public parks etc. to promote healthy lifestyle and to
reduce adverse effects of environmental pollutions and development works on public health
.
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18. Involvement of MoHPin addressing the burden of NCDs
Non-communicable disease and Mental health section is functioning under
Epidemiology and Disease Control Division to support NCD programs.
•It Provides support to the Ministry of Health and Population in drafting national laws,
policies and strategies necessary for the management of cancer, COPD and other non-
communicable diseases.
•Prepare standards, protocols and guidelines for the prevention and management of
cancer, diabetes, CVDs, COPD and other non- communicable diseases in health
institutions at different level and ensure quality standard of services.
•Provide support and coordinate with provincial and local level for the prevention,
treatment and management of non- communicable diseases.
•Provide support for preparation and implementation of federal level annual work plan
for disease control and management.
•Coordinate for the planning and implementation of healthy lifestyle promotion and
behavior change program activities for prevention of NCDs.
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19. Involvement of MoHPin addressing the burden of NCDs………………….
•Facilitate in logistic management of medicines, medical equipmentsand
instruments used in prevention and management of NCDs.
•Provide support and coordinate in Information management training and other
federal activities associated with cancer, diabetes, CVDs, COPD and other non-
communicable diseases.
•Provide support at national level in monitoring and evaluation, conducting
surveys, surveillance and research works associated with cancer, diabetes,
CVDs, COPD and other non- communicable diseases.
•Provide support to the Ministry of Health and Population in drafting national
laws, policies and strategies related to mental health.
•Prepare standards, protocols and guidelines regarding counseling and
treatment services associated with mental health provided by health
institutions at different level and ensure quality standard of services.
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20. Involvement of MoHPin addressing the burden of NCDs………………….
•Assist and coordinate for the prevention, treatment and management of
mental health problems at the provincial and local level.
•Provide support for preparation and implementation of federal level annual
work plan related to mental health.
•Provide support and coordinate in mental health training and research works.
•Facilitate in procurement and logistics management of medicines, medical
equipment and instruments related to mental health.
•Provide support and coordinate in Information management training and other
federal activities associated with mental health service delivery and
management.
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21. Involvement of MoHPin addressing the burden of NCDs………………….
•Provide support and coordinate in social rehabilitation and management of
people suffering from mental health problems.
•Provide support at national level in monitoring and evaluation, conducting
surveys, surveillance and research works associated with mental health.
Implementation of a multisectoral approach is key to effectively addressing
the rising burden of noncommunicable diseases. Aligned with this principle, the
Government of Nepal has endorsed the second Multisectoral Action
Plan (MSAP- II) on prevention and control of NCDs in 2021-2025.
•The goal of MSAP-II is to reduce burden of NCDs through “whole of
government”and “whole of society” approach. The overarching target is
to reduce premature death from major NCDs by 25% by 2025 and by one
third by 2030.
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22. NCDs as a issue of Development
•NCDs are health as well as development and human rights issue , as they
disproportionately affect the poorest and most vulnerable populations.
NCD risk factors are prevalent more among poorer communities with
lower socioeconomic status.
•A country’s stage of economic development, cultural factors, and social
and health policiesalso influence the NCD.
•People in poor countries have worse access to health care for timely diagnosis and treatment of NCDs.
•In LMICs, out-of-pocket expenditure is high for the treatment and care of
NCDs. Out-of-pocket health expenses push millions of people into poverty.
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23. Ecological imbalance and health
•Ecology is a science that studies the interdependent and interconnected
relationships between the organisms and their physical environment on the
one hand and among the organism on the other hand.
•An ecosystem can be categorized into its abiotic constituents , including soil,
water, minerals, climate, sunlight and all other non-living elements and its
biotic constituents, consisting of all its living organisms.
•Ecological balance has been defined as the balance between production and consumption of each element in the ecosystem.
•This balance may be disturbed due to the introduction of new species, the
sudden death of some species, natural hazards and man-made causes.
•Ecological imbalance is a multi- causal phenomenon
•Ecological balance is important for the health and stability of an ecosystem
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24. •Equilibrium involves stability between living beings and the environment,
buthumans have made the massive consumption of natural resources that
causes the ecological imbalance.
•The causes of ecological imbalance can be either natural and man- made.
•The most obvious natural causes are climate change, global warming, global dimming and invasive species, while the most obvious man- made causes are
resource exploitation and environmental pollution.
•
Ecological imbalance between the natural factors and human activities is socio-
ecological crisis. This implies that the balance between the environment and
society is broken.
•This situation can lead to the destruction of humanity.
•The reasons for ecological imbalance are connected with the increasing industrialization
, deforestation, degradation of land and soil erosion, irrational
waste of natural resources, pollutionand it also causes ecological disaster.
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25. Causes of ecological imbalances in Nepal
•Degradation of land and soil erosion
•Deforestation
•Faulty utilization of water resources
•Environmental problems from faulty mining practices
•Industrial, ill- maintained automobiles and atmospheric pollution
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26. Consequences of ecological imbalance
On human health:
•Polluted air, water and soil create numerous harmful chemical and
biological agents that have a negative impact on human health. A wide
range of communicable as well non-communicable diseases can be spread
through ecological imbalance.
•Different infectious diseases are cause due to ecological imbalance
•Environmental conditions such as heavy metals and air pollution have been
linked with the incidence and mortality of chronic diseases such as cancer,
as well as cardiovascular and respiratory diseases.
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27. •Global warming (due to green house effect) and climate change: it leads
to increased heatwaves, floods and other climate related health risks
including health-stress, malnutrition and vector borne diseases (e.g.
malaria, dengue etc.)
•Contamination of food: Chemical contamination reach food and livestock
feed from many sources. Pesticides used in farms. Veterinary drugs and
animal growth promoting chemical pass into meat and daily products.
Crops may be chemically contaminated by the airborne deposition of
industrial emissions or effluents.
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