(NCDs) - الصفحات الشخصية | الجامعة الإسلامية بغزةsite.iugaza.edu.ps/ajedi/files/2010/02/NCDs.pdf · 2009-12-15 · services and the increasing level

Non communicable diseases

(NCDs)

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Non communicable diseases (NCDs)

ó Is a disease which is not infectious. Such diseases may result from genetic or lifestyle factors. ó A non-communicable disease is an illness that is

caused by something other than a pathogen. ó It might result from hereditary factors, improper

diet, smoking, or other factors. Those resulting from lifestyle factors are sometimes called diseases of affluence.

ó Examples include hypertension, diabetes, cardiovascular disease, cancer, and mental health problems, asthma, atheroclorosis,allergy ect. ó The non-communicable diseases are spread by:

heredity, surroundings and behavior. ó Approximately, 17 million people die prematurely

each year as a result of the global epidemic of chronic diseases ó The risks of high blood pressure and high blood

cholesterol, tobacco and excessive alcohol consumption, obesity and physical inactivity were more commonly associated with affluent societies. ó becoming dominant in all middle and low income

countries and not limited to the effluent countries ó NCDs, is responsible for almost 60% of world

deaths (31.7 million deaths) and 43% of the global burden of diseases.

This increase is clearly related to changes in global dietary patterns and increased consumption of industrially processed fatty, salty and sugary foods

ó In its 2003 annual report, MOH stated that it

considers (NCDs)caused by unhealthy diets and



habits to be just as serious as those caused by under-nutrition

NCDs Situation in Palestine: NCDs are the leading cause of death among adult population in the Palestinian society. contribute to more than 50% of causes of death among adults common Risk factors to NCDs in Palestinian population. ó Tobacco consumption is among the highest in

the world. ó Diet rich in saturated fat, and in simple sugars,

with the decreased consumption of fibers, whole grain foods, and complex carbohydrates has lead to the increased prevalence of these illnesse. ó Keeping in mind the current situation of health

services and the increasing level of poverty, there should be a special concern of disability related to NCDs.

Health services today will not be able to meet the challenges of (NCDs) In Palestine ó No or weak national data is available on the overall

incidence and prevalence ofNCDs. ó In general we depend on mortality data to estimate

the impacts of these diseases. ó No classification by age orgender Neither is there

any information on disabilities resulting from any of the chronic diseases



ó The current system counts mainly the visits of the patients to PHC

centers, which does not reflect the real prevalence andincidence. fragmentation in reporting and managing system regarding NCDs in general and DM in specific. This lack of information leads to: - Inability to estimate the direct and indirect cost; resources required e.g. drugs, policy; and decisionmaking regarding prevention and treatment Some Continuing Challenges

ó Lack of national policies for NCD prevention

and control ó Low resources - only 1/3 of countries have a

budget line for NCD prevention & control. ó Lack of NCD surveillance systems ó Fragmented and uncoordinated care ó PHC capacity to deal with NCDs is poor

*NCD CHALLENGES Cost Pressures Disease burden, interventions, drugs Quality of Care Care teams, medical records, QIP & financial incentives Prevention Fragmentation, lack of protocols, lack of financial incentives/support Poverty



*CHANGES NEEDED

Comprehensiveness ó With policy/legislation support

Coordination ó Information flows

Continuity ó Organized Care

Communication ó Orient. on self management

Community linkages How to strengthen health systems for NCDs? ¯ Financing (increased, better and sustained ¯ Regulation (assured quality and affordability) ¯ Service Delivery (ensured access and

availability) ¯ Governance (improved performance)

1-Obesity ó Obesity is a condition in which people have an

excess of body fat. ó According to (CDC), the prevalence of

obesity in the U.S more than doubled between the years 1960 and 2000, with the greatest increase from 1980 forward.



ó According to the National Institutes of Health, almost one-third of Americans are obese. ó Obesity is growing problem across the globe. ó Worldwide, more than 300 million adults are

obese, according to (WHO). ó obesity is the second-leading cause of

preventable death in the U.S, surpassed only by smoking. At least 300,000 Americans die each year as a result of factors attributed to obesity, American Obesity Association

Obesity is a major risk factor for a number of serious health conditions, including: ó Coronary heart disease. ó Cancer. ó Diabetes. ó Fatty liver disease. ó Gallbladder disease. ó High blood pressure.. ó Osteoarthritis. ó Stroke. ó Sleep apnea and other breathing problems.

Classification Obesity, in absolute terms, is an increase of body adipose tissue (fat tissue) mass. BMI Body mass index or BMI is a simple and widely used method for estimating body fat mass.[8] BMI



was developed in the 19th century by the Belgian statistician ó BMI is an accurate reflection of body fat

percentage in the majority of the adult population. It is less accurate in people such as body builders and pregnant women in whom body composition is affected. ó BMI is calculated by dividing the subject's

weight by the square of his or her height, typically expressed either in metric .

Metric: BMI = kg / m2

Classification BMI

underweight Less than 18.5

normal weight 18.5–24.9

overweight 25.0–29.9 is

class I obesity 30.0–34.9 is

class II obesity 35.0–39.9 ó The surgical literature breaks down "class III" obesity

into further categories. ó Any BMI > 40 is severe obesity ó A BMI of 40.0–49.9 is morbid obesity ó A BMI of >50 is super obese

Gabriel I Uwaifo (June 19, 2006). "Obesity". Retrieved on 2008-09-29.



2-Cancer

Cancer ó medical term: (malignant neoplasm) is a class

of diseases in which a group of cells display uncontrolled growth .invasion and sometimes metastasis (spread to other locations in the body via lymph or blood . ó Cancer may affect people at all ages, even

fetuses, but the risk for most varieties increases with age. ó Cancer causes about 13% of all deaths. ó According to the American Cancer Society,

7.6 million people died from cancer in the world during 2007. ó Cancers can affect all animals.



3-Hypertension

Definition Hypertension is high blood pressure. Blood pressure is the force of blood pushing against the walls of arteries as it flows through them. Classification of hypertension : Essential ( primary ) Hypertension : it indicates that no specific medical cause can be found to explain a patient's condition, from the patients diagnosed with hypertension, 95% fall in the category of essential (or idiopathic) hypertension. Secondary Hypertension : indicates that the high blood pressure is a result of (i.e. secondary to) another condition, such as kidney disease or tumors, 5% will fall in the category of secondary hypertension. Risk factors for hypertension include:

*Modifiable ó Body weight ó Sodium chloride intake ó Alcohol intake ó Physical activity ó Psychosocial factors ó Socio-economic status ó Hormonal contraceptives



*Non-modifiable ó Age ó Sex/gender ó Heredity ó Ethnicity/race

Global burden of hypertension The biggest increase in prevalence was expected to be in developing (increase of 24%) and third world countries (increase of 80%) as the rapidly take on the more western lifestyle. Scientists are now claiming that 1 in 3 adults in the world will have high blood pressure in 2025. By 2025, the number will increase by about 60% to a total of 1.56 billion as the proportion of elderly people will increase significantly. Prevalence of hypertension can differ according to gender and age.

Men are at increased risk for high blood pressure as compared to women until the age of 55. After 55, there is a higher percentage of women at risk for high blood pressure.

High blood pressure is 2 to 3 times more common in women taking oral contraceptives, especially in obese and older women, than in women not taking them.

64% of men over 75 years old have hypertension.



77% of women over 75 years old have hypertension.

Older females have a significant risk of developing high blood pressure. More than 50% of women over age 60 have high blood pressure.

African-Americans who live in the United States have the highest prevalence of hypertension in the world. ( WHO )

In USA Hypertension affects 65 million adults in the United States. The prevalence of hypertension is higher at the older ages. In Palestine In Palestine, no or weak national data are available on the overall incidence and prevalence of cardiovascular diseases (CVD), hypertension diseases, Diabetes Mellitus (DM) and accidents. In general we depend on mortality data to estimate the impacts of these diseases. The current system counts mainly the visits of the patients to PHC, which does not reflect the real prevalence or incidence. Besides, there is no classification by age or gender mainly because of no computerized system.



Prevalence of the disease : ó There were no reports of having this disease

for those under the age of 18. Prevalence within the elderly people :-

The Palestinian Central Bureau of Statistics study the situation of elderly in the Palestinian Territory in 2005 .

The report defines the elderly people as of age 65 years and over.

Number of elderly in the Palestinian Territory in mid year 2005 are 114.8 thousands person (49.3 thousands males and 65.5 thousands females),

Hypertension disease Mortality in 2005 :

Hypertension disease is the fifth-leading cause of cardiovascular diseases deaths; 12.9% of the total cardiovascular mortality, with a rate of 13.0 per 100,000.

• Hypertension disease is the eight-leading cause

of deaths in total population (4.8%), while it was the ninth leading deaths in males and females (2.7% and 3.8%) of males and females deaths respectively.



4-Cardiovascular Disease Introduction Non communicable disease account for a large and increasing burden of disease worldwide. It is currently estimated that non communicable disease accounts for approximately 59% of global deaths and 43% of global disease burden. This is projected to increase to 73% of deaths and 60% of disease burden by 2020. The worldwide burden of cardiovascular disease is substantial. In most industrialized countries, cardiovascular disease are the leading cause of disability and death. Developing countries, with previous low rate are now seeing increased rates as economic develop, infectious disease are conquered and life expectancy improves. Definition Cardiovascular disease refers to the class of diseases that involve the heart or blood vessels (arteries and veins). While the term technically refers to any disease that affects the cardiovascular system, it is usually used to refer to those related to atherosclerosis (arterial disease). CVD are present in many forms and have different categories and include:-

Hypertension (high blood pressure) Coronary heart disease (heart attack)



Cerebrovascular disease (stroke) Peripheral vascular disease Heart failure Rheumatic heart disease Congenital heart disease Cardiomyopathies

Risk factors for cardiovascular disease q Non-modifiable Risk Factors Ø Age Ø Gender, men under the age 64 are much more

likely to die of coronary heart disease than women, although anyone can die from it. Ø Genetic factors/Family history of

cardiovascular disease. Ø Race (or ethnicity), Studies show that blacks

are twice as likely to develop high blood pressure as Caucasians. Ø Environment, your chances can increase

because of areas with a lot of smog or other form of air pollution, including passive smoking.

q Modifiable Risk Factors

cigarette smoking, high cholesterol and high blood Pressure, lack of exercise, diabetes, obesity, too much alcohol, certain infections and inflammation, estrogens, androgens, and certain psychosocial factors.



Risk factors for CVD in Palestine q There is little published information on the

cardiovascular disease risk factors of Palestinian population. q The study was aim to identify the most

common coronary heart disease risk factors among adult population in Gaza Strip to develop preventive health education and health promotion programs

This study shown that the most common identified CHD risk factors were physical inactivity 53%, hypertension and obesity 43% for each, family history 38%, diabetes mellitus 34%, high LDL-c 34%, elevated cholesterol level 33%, smoking 29%, low HDL-c 27%, hyperuricemia 25%, and elevated triglycerides level 14% Other study conducted by Heart Institute and Epidemiology Unit, Hadassah-Hebrew University Medical Center, Jerusalem, evaluated the coronary risk characteristics of Palestinian and Israeli women with coronary artery disease in Jerusalem. The study finding reflect that Palestinian Arab women in Jerusalem appear to have more diabetes and exhibit lifestyle factors (lower socioeconomic status, suffered more passive smoking and were less physically active) that generally increase the risk for CHD than Jewish women.



Risk factors conclusion & recommendation Ø The result of previous studies seems to be that

most of the identified CHD risk factors could be preventable. Ø These results may highlight the problem as a

public in nature that need community-based intervention programs integrated to health education programs. Ø According to these result greater attention to

primary prevention is needed. Ø These result suggests the need investigate

determinants of the metabolic syndrome and the possible role of passive smoking in Arab women as well as modes of intervention via health promotion and risk factor management in this population.

Global Burden of Cardiovascular Disease Cardiovascular disease is the number one cause of death globally and is projected to remain the leading cause of death. An estimated 17.5 million people died from cardiovascular disease in 2005, representing 30 % of all global deaths. Of these deaths, 7.6 million were due to heart attacks and 5.7 million were due to stroke.



Around 80% of these deaths occurred in low and middle income countries (LMIC). If appropriate action is not taken, by 2015, an estimated 20 million people will die from cardiovascular disease every year, mainly from heart attacks and strokes. (WHO, 2005) American Heart Association, 2006. Estimates for the year 2005 are that 80,700,000 people in the United States have one or more forms of cardiovascular disease (CVD).

• High blood pressure — 73,000,000. • Coronary heart disease — 16,000,000. § Myocardial infarction (acute heart attack) —

8,100,000. § Angina pectoris (chest pain or discomfort

caused by reduced blood supply to the heart muscle) — 9,100,000.

• Stroke — 5,800,000. • Heart Failure — 5,300,000

Over 142,000 Americans killed by CVD in 2004 are under age 65 2004 death rates from CVD were 335.1 for white males and 454.0 for black males; for white females 238.0 and for black females 333.6 (Death rates are per 100,000 population. From 1993 to 2003 death rates from CVD declined 24.7 percent.



Despite this decline in the death rate, in the same 10-year period the actual number of deaths declined only 8 percent. Cardiovascular disease in Palestine Cardiovascular disease (CVDs), principally heart diseases is the first leading cause of death among population in Palestine in the year 2005 exactly as it is in the whole world. This involves males and females with a proportion of 18.7% and 19.9% respectively of the total number of death in Palestine. Cardiovascular diseases and stroke are major cause of illness, disability and death in Palestine, which causes an increase in personal, community and health care costs. This really requires a competent plan to address this important and serious issue. There are no available data to suggest the overall prevalence or incidence of cardiovascular disease and hypertension, we depend on mortality data from the different health centers to estimate the impact of theses diseases on society. Cardiovascular Disease Mortality Indicator Mortality rate per 100,000 of cardiovascular diseases was: • All heart diseases 56.8 • Rheumatic HD 0.7



• Ischemic HD 36.4 • Pulmonary HD 1.6 • Other heart diseases 18.1 • CVA 29.8 • Essential hypertension 13 Statistics In 2005, 3,799 persons died from cardiovascular diseases (1,956 males and 1,843 females), with a proportion of 36.7% of total deaths, with a rate of 101/100,000 population. Mortality among males was higher than females (51.5% in males and 48.5% in females). Cardiovascular mortalities are ranking as following:

1. All heart diseases (Ischaemic, Rheumatic, Pulmonary and Other Heart diseases), constitute 56.8% of cardiovascular diseases with a rate of 54.4 per 100,000 population

2. Ischaemic heart disease constitutes 37.5% of cardiovascular diseases with a rate of 35.9 per 100,000 population;

Cerebrovascular disease constitutes 24.4% of CVDs with a rate of 23.4 per 100,000 population.

4. Hypertensive disease constitutes 17.4% of cardiovascular diseases with a rate of 16.6 per 100,000 population.



5. Other heart diseases constitutes 17.4% of cardiovascular diseases with a rate of 16.7 per 100,000 population.

5-Diabetes Mellitus

Definition of DM Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin, or alternatively, when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar Etiologic Classification of Diabetes Mellitus

b-cell destruction with lack of insulin

Type1

Insulin resistance with insulin deficiency

Type2

Genetic defects in b-cell exocrine pancreas diseases drug- or

chemical induced, and other rare forms

Other specific types

Insulin resistance with b-cell dysfunction

Gestational

Complications of Diabetes Macrovascular



Brain Cerebrovascular disease

• Transient ischemic attack • Cerebrovascular accident • Cognitive impairment

Heart Coronary artery disease

• Coronary syndrome • Myocardial infarction • Congestive heart failure

Extremities Peripheral vascular disease

• Ulceration • Gangrene • Amputation

Microvascular Eye Retinopathy Cataracts Glaucoma Kidney Nephropathy

• Microalbuminuria • Gross albuminuria • Kidney failure

Nerves Neuropathy

• Peripheral • Autonomic



• "Diabetes is a major threat to global public health that is rapidly getting worse, and the biggest impact is on adults of working age in developing countries. At least 171 million people worldwide have diabetes. This figure is likely to more than double by 2030 to reach 366 million."

Epidemiology ó In 2000, according to the World Health

Organization, at least 171 million people worldwide suffer from diabetes. Its incidence is increasing rapidly, and it is estimated that by the year 2030, this number will double. ó Prevalence of Diabetes mellitus among

population above 20 years in 2005 was 11%.(WHO,2006) ó Diabetes is in the top 10, and perhaps the top

5, of the most significant diseases in the developed world. (Wikipedia) ó According to the American Diabetes

Association, approximately 18.3% (8.6 million) of Americans age 60 and older have diabetes. Diabetes mellitus prevalence increases with age. (ADA, 2004). ó The National Diabetes Information

Clearinghouse estimates that diabetes costs $132 billion in the United States alone every year (Eberhart, MS et al, 2004).



Diabetes frequency is dramatically rising all over the world ó The World Health Organization (WHO)

estimates that more than 180 million people worldwide have diabetes. This number is likely to more than double by 2030. ó In 2005, an estimated 1.1 million people died

from diabetes. ó Almost 80% of diabetes deaths occur in low

and middle-income countries. ó The global increase in diabetes will occur

because of population ageing and growth, and because of increasing trends towards obesity, unhealthy diets and sedentary lifestyles. ó Worldwide, 3.2 million deaths are attributable

to diabetes every year. ó One in 20 deaths is attributable to diabetes;

8,700 deaths every day; six deaths every minute. ó At least one in ten deaths among adults

between 35 and 64 years old is attributable to diabetes . ó Three-quarters of the deaths among people

with diabetes aged under 35 years are due to their condition. ó Almost half of diabetes deaths occur in people

under the age of 70 years; 55% of In developing countries the number of people with diabetes will increase by 150% in the next 25 years.



In developed countries most people with diabetes are above the age of retirement, whereas in developing countries those most frequently affected are aged between 35 and 64.

WHO projects that diabetes deaths will increase by more than 50% in the next 10 years without urgent action. Most notably, diabetes deaths are projected to increase by over 80% in upper-middle income countries between 2006 and 2015. ó In the developed world, diabetes is the most

significant cause of adult blindness in the non-elderly, the leading cause of non-traumatic amputation in adults, and diabetic nephropathy is the main illness requiring renal dialysis in the United States.

Diabetes in Palestine According to WHO global estimate and the epidemic nature of diabetes; prevalence of diabetes is expected to increase in Palestine and figures should be revised to have more realistic estimation which enables health providers to be aware of the size of the problem so more effective health strategies can be adopted. Prevalence of DM ó The prevalence of DM in Palestine was based

on a study conducted in 2000 in cooperation



with Al Quds University and MOH. The preliminary results indicated that the prevalence DM in Palestine is about 9% in 2000. It is around the reported prevalence rate in Egypt and Tunisia (9%) and less than in Saudi Arabia (12%) and Oman (13%). ó The gap between the expected prevalence rates

of DM and cases under supervision reflects under registration and underreporting and also requires special efforts to accelerate early case finding activities in order to avoid high cost of treating the complications and disability consequences of the disease. Also this will give more realistic estimation of the prevalence for appropriate evaluation of the problem.(MOH, 2006)

New cases of Diabetes mellitus in West Bank clinics In 2005, out of total 2,741 new reported cases of diabetes in the West Bank diabetic clinics, out of them28.2% was among age group of (55-64), 41.0% amongage group of 35-54 years, 6.3% among age less than 35years, 24.4% among age 65 years and over. Distribution of diabetic (type II) cases by management in the West Bank health clinic: ó 1. About 28.6% of diabetics’ cases were

managed by insulin treatment.



ó 2. About 5.0% were treated with a combined therapy (insulin and OHA). ó 3. About 64.7% of diabetics' cases were

managed by tablets. ó 4. Diet control (exclusively managed by

lifestyle modification) was 1.7% Mortality among Palestinian refugee A total of 2,721 deaths which accounted for 2 per cent of all non communicable disease patients were reported during 2005. 48.2 per cent of them have diabetes and hypertension combined, 36.4 per cent have hypertension and 15.4 per cent have diabetes (UNRWA Annual Report, 2005). Mortality of diabetes mellitus ó In Palestine: DM did not report a one of the

10th leading cause of death among Palestinians. It constituted 3.6% of total population deaths. 372 persons died with mortality rate of 10.2 per 100,000 (176 males, with a rate of 9.5 per 100,000 males and 196 females, with mortality rate of 10.9 per 100,000). The average annual mortality rate of DM was 12.4 per 100,000 population in the last five years. ó In Gaza Strip: 215 persons died with mortality

rate of 16.1 per 100,000 (98 males and 117 females). In West Bank: 157 persons died



with mortality rate of 6.8 per 100,000 (78 males and 79 females).

Major risk factors

ó Family history ó Obesity ó Age (older than 45) ó History of gestational diabetes ó High cholesterol ó Hypertension

Prevention of effects combination approach

Increased exercise Decreases need for insulin

ó Reduce calorie intake Improves insulin sensitivity

ó Weight reduction Improves insulin action Triad of Treatment *Diet

ó Lower calorie ó Fewer foods of “high glycemic index” ó Spread meals evenly

*Anti-Diabetic medications ó Oral hypoglycemic agents



ó Sulfonylureas ó Thiazolidinediones ó Biguanides ó Alpha-glucosidase inhibitors ó D-phenylalinine derivatives

Insulins

*Exercise



Documents

(NCDs) - الصفحات الشخصية | الجامعة الإسلامية بغزةsite.iugaza.edu.ps/ajedi/files/2010/02/NCDs.pdf · 2009-12-15 · services and the increasing level