Prevention and Control of Non-Communicable diseases (NCDs).pptx

Presentation on NCD prevention and control

1. Prevention and Control of Non-Communicable Diseases Dr Jaydeep Ghevariya Resident Doctor Department of community medicine, B J medical college, Ahmedabad. 1

2. NCD - Cardiovascular diseases Coronary heart disease Hypertension Stroke Rheumatic Heart Disease Diabetes Cancers Obesity Blindness Oral Diseases COPD Mental problems Accidents and injuries 2

3. Burden of chronic diseases: the rising tide contributed to an estimated 72% of deaths globally in 2016, previously it was 53% in 2005 . Nearly 2/3 rd of this deaths occurs in low- and middle- income countries. Leading causes of deaths in NCDs are Cardiovascular disease (44%), Cancers (16%), Respiratory diseases (9%), Diabetes (4%)(2016). Many of these deaths occur at relatively early ages, Compared with all other countries. 3

4. Proportional Mortality in india (2016) 4

5. WHO STEP-wise approach to NCD surveillance 5

6. Risk factors Demographic, Economic, and Social factors Urbanization, Industrialization, and Globalization – increases metabolic syndrome, increases behavioral risk Age -Increased life expectancy Tobacco use – 7 million people die from tobacco from each year. 0.6 million death by second hand smoke out of which 28% are children. It causes lung cancers (71%), chronic respiratory disease (42%), and cardiovascular disease (10%). India is the world’s second largest producer as well as consumer of tobacco. 6

7. Risk factors Overweight and Obesity- 2.8 million people dies due to obesity or overweight. Risk of heart disease, stroke and diabetes increase steadily with increasing BMI. In 2016 11% of men and 15% of women aged 18 years and above are obese. More than 42 million children under the age of 5 years were overweight. Factors are poor- imbalanced diet, high energy intake and lack of exercise. Insufficient physical activity- 1.6 million people die due to physical inactivity. Insufficient physical activity have a 20% to 30% increases risk of all-cause mortality. 7

8. Risk factors Harmful use of alcohol- 3.3 million people die due to harmful use of alcohol, accounting 5.9% of all deaths. Harmful effect of alcohol determined by volume of alcohol consumed, pattern of consumption and quality of alcohol consumption. Unhealthy diet- Inadequate consumption of fruit and vegetables increase the risk of cardiovascular disease, stomach and colon cancer. High salt consumption increase risk of cardiovascular and hypertension. Raised cholesterol- it increases the risk of heart disease and stroke. Levels of awareness, treatment, and adequate control are low for hypertension, diabetes, and dyslipidemia, especially in rural area 8

9. Gaps in natural history- 9

10. Why common NHP - Up to 80% of heart disease, stroke and type 2 diabetes and over a third of cancers could be prevented by eliminating shared risk factors, mainly tobacco use, unhealthy diet, physical inactivity and the harmful use of alcohol. 10

11. Why comprehensive multisectoral NHP - 11

12. Prevention 12

13. Prevention Interventions are- Tobacco- Protect people from tobacco smoke, ban tobacco smoke in public, warning about tobacco use on packages, ban on tobacco advertising, promotion and sponsorship, raising taxes on tobacco products. Alcohol- Restriction on access to retailed alcohol, restriction on advertising Increase taxes. Salt- Reduce salt intake and salt content of food Fat- reducing trans fat with polyunsaturated fats Health promotion- promoting public awareness about diet, and physical activity, use of mass media for health promotion 13

14. Prevention Other interventions to reduce risk factors – Nicotine dependence treatment Enforcing drink-driving law Restriction of marketing of food with high salt, sugar and fat Food taxes and subsidies to promote healthy diets Healthy nutritional environment in schools Nutrition information and counseling in health care. National physical activity guidelines. 14

15. Prevention Other interventions to reduce risk factors – Vaccination against hepatitis B; a major cause of hepatic cancer Vaccination against HPV; main cause of cervical cancer. Protection against environmental or occupational risk factors for cancer, such as aflatoxin, asbestosis and contaminated drinking water. 15

16. Strategies - Comprehensive strategy/ multisectoral policies/ integrated approach for their prevention and control is needed. P & C of NCD as part of Primary health care system Primary prevention – Population approach health promotion, Risk reduction. High risk strategy - risk detection, Secondary prevention Tertiary prevention 16

17. Benefits of exercise - 17

18. Legislations - 18

19. Health programs - 19

20. NPCDCS (2010-11) National program for preventive and control of cancer, diabetes, CVD, and stroke 20

21. NPCDCS Non-communicable diseases (NCDs) are the leading cause of adult mortality and morbidity worldwide.   Keeping in view that there are common preventable risk factors for Cancer, Diabetes, CVD & Stroke, Government of India initiated a National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) during 2010-11 after integrating the National Cancer Control Programme (NCCP) with National Programme for Prevention and Control of Diabetes, Cardiovascular Diseases and Stroke (NPDCS). 21

22. NPCDCS Two component s of NPCDCS- DCS- Diabetes, cardiovascular disease and stroke component Cancer- component Objectives : Prevent and control common NCDs through behaviour and life style changes, Provide early diagnosis and management of common NCDs, Build capacity at various levels of health care for prevention, diagnosis and treatment of common NCDs, Train human resource within the public health setup viz doctors, paramedics and nursing staff to cope with the increasing burden of  NCDs Establish and develop capacity for palliative and rehabilitative care. 22

23. NPCDCS Strategy Health promotion, Awareness generation and promotion of healthy lifestyle Screening and early detection Timely, affordable and accurate diagnosis Access to affordable treatment, Rehabilitation 23

24. NPCDCS- Activities/ Interventions adopted Health promotion- Increased intake of healthy foods Salt reduction Increased physical activity/regular exercise Avoidance of tobacco and alcohol Reduction of obesity Stress management Awareness about warning signs of cancer etc. Regular health check-up Interpersonal communication is to be carried out through ASHAs/ AWWs/Youth clubs, panchayat members etc. Targeted intervention programmes are being designed to bring awareness in schools and workplaces. 24

25. NPCDCS- Activities/ Interventions adopted Screening Diagnosis Screening and early detection of diabetes, high blood pressure and common. •Target population (age 30 years and above, and pregnant women) will be conducted either through opportunistic and/or camp approach at different levels of health facilities and also in urban slums of large cities. •The screening of the urban slum population would be carried out by the local government/municipalities in cities with population of more than 1 million. •The screening of school children will be carried out during the routine school health check-up activity under the school health programme. •The suspected cases of diabetes and high blood pressure will be referred to higher health facilities for further diagnosis and treatment. 25

26. NPCDCS- Activities/ Interventions adopted Screening Diagnosis Opportunistic screening for common cancers (breast, cervical and oral) among the population 30 years and above. Screening for prostate cancer at CHC and DH levels in 60 years+ male The HW (F) will be trained for conducting For screening of diabetes, support for glucometers, glucostrips and lancets would be provided to the states under NHM. AYUSH doctors can play an important role in prevention and control of NCDs through primary health care network. They are involved in health promotion activities through behaviour change, counselling of patients and their relatives on healthy lifestyle (healthy diet, physical activity, salt reduction, avoidance of alcohol and tobacco) meditation, yoga, opportunistic screening for early detection of non-communicable diseases and their risk factors. 26

27. NPCDCS- Activities/ Interventions adopted Screening Diagnosis Hub and spoke model is proposed for providing comprehensive care, where hub would be the tertiary care hospital/Medical College and spokes would be the districts. • The suspected cases from the periphery will be referred to Tertiary Care facilities. • The common infrastructure/manpower is utilised at peripheral level for early detection of cases, diagnosis, treatment, training and monitoring of programmes such as National Programme for Prevention and Control of Cancer, Diabetes, CVDs and Stroke (NPCDCS), National Programme for Health Care of Elderly (NPHCE), National Tobacco Control Programme (NTCP), National Mental Health Programme (NMHP) etc. 27

28. NPCDCS 28

29. FACILITIES AT DIFFERENT HEALTH CARE LEVEL

30. Primary Health Centres (PHC)

31. Community Health Centres (CHC)

32. District Hospitals

33. Tertiary Cancer Centre (TCC)

34. CANCER COMPONENT UNDER NPCDCS

35. National cancer control Programme Objectives- Primary prevention- health education Secondary prevention- early detection and diagnosis of common cancer of mouth, cervix, breast, tobacco related cancer by screening or self examination. Tertiary prevention- strengthening of the institutes for comprehensive therapy including palliative care. Schemes- Financial assistance to voluntary organizations District cancer control scheme Financial assistance for Cobalt Unit installation Development of oncology wings in Government Medical College hospitals Assistance for regional research and treatment centers 35

36. CANCER SERVICES UNDER NCPDCS Common Diagnostic Service- Basic Surgery, Chemotherapy and Palliative care for cancer cases is made at 100 District Hospitals. Each district is being supported by Rs. 1.66 Crores per annum for the following- Chemotherapy drugs are provided for 100 patients at each District Hospital. Day care Chemotherapy facilities is being established at 100 District Hospitals. Facility for lab investigation including mammography is being provided at 100 District Hospitals. Home based palliative care is being provided for chronic, debilitating and progressive cancer patients at 100 District Hospitals. Support is being provided by contractual man power through 1 Medical Oncologist, 1 Cyto-pathologist, 1 Cyto-pathology Technician, 2 Nurses for day care.

37. GUIDELINES FOR REFERRAL AND TREATMENT under NPCDCS Government of India has developed operational guidelines in for prevention, screening and control of common, non-communicable diseases. Those who systolic BP more than 140 and Diastolic BP more than 190, Random Blood sugar 140 & above would be referred to Medical Officer at the nearest health facility for confirmation, conducting lab investigation and initiation of treatment. Those who are found positive for pre cancerous/ cancer lesion will be referred by ANM/ Staff nurse in specified screening site to the appropriate PHC/CHC/District Hospital for confirmation and treatment by trained specialists.

38. GUIDELINES FOR REFERRAL AND TREATMENT under NPCDCS Once the diagnosis of DM/HTN is established patient must receive at least one month drug from PHC. Once the condition is stable provide the patient with a 3 month supply of Drug with the ANM/ASHA visiting the patient each month for ensuring, compliance, checking on diet and life style modification BP & Blood Sugar. Patient will go to the PHC for first follow-up at the end of the first three month after diagnosis or sooner if required. An annual specialist consultation at the nodal CHC with NCD clinic is also recommended. Those individual who are on treatment under care of private practitioner they could be offered the choice of taking drugs from the Public Health System.

39. NPCDCS- indicator and targets 39

40. NEW INITIATIVES UNDER THE PROGRAMME

41. Key provisions of the Indian Tobacco Control Act, 2003 Ban on smoking in public places Ban on direct and indirect advertisement of cigarettes and other tobacco products in print, electronic and outdoor media (ban on tobacco use in films to be implemented from October, 2005) Ban on sales to and by people younger than 18 years Tobacco products cannot be sold near educational institutions Mandatory depiction of statutory health warning (in one or more Indian languages) and pictorial warning, on all tobacco products Product regulation: tar and nicotine levels to be declared on tobacco product packages 41

42. 2030 Agenda for Sustainable development Target 3.4- 1/3 rd reduction of premature mortality from NCDs by the year of 2030 and extension of global NCD mortality target. 42

43. Thank you 43