Epidemiology ofNon- Communicable

Diseases(NCD)Dr. AREMU A.O

MB.BS,M.P.H, FWACP

Community Medicine Dept

BOWEN UNIVERSITY

INTRODUCTION• Also called chronic disease epidemiology

• Assuming increasing importance in both developed and developing countries.

• There is an epidemiological transition from communicable diseases. Peri-natal and nutritional disorders to predominantly NCDs in Nigeria.

• NCDs are increasingly becoming an important contributor to the national diseases burden and therefore a major public health concern.

NCDs• NCDs are usually chronic diseases that are typically

non contagious, non infectious and not transferred from person to person.

• NCDs result from genetic or lifestyle factors (risk factors).

• NCDs cause death, dysfunction, or impairment in the quality of life.

• NCDs include injuries (RTI)

• NCDs are leading cause of functionary impairment and death worldwide.

• Among the top ten causes of morbidity and mortality in Nigeria.

• Adults are more affected except SCD.

• Imposes heavy economic burden on individuals, societies and the health system.

• As the leading cause of death globally, NCDs were responsible for 38 million (68%) of the world’s 56 million deaths in 2012.

• More than 40% of them (16million) were premature deaths under age 70 years. Almost three quarters of all NCD deaths (28 million),

• Majority of premature deaths (82%), occur in low- and middle-income countries.

NCDs are assuming greater importance because –

•Control of communicable diseases-malaria, diarrhoea dxs, respiratory tract infections etc

•Urbanization and industrialization

• Life style and behaviour

• Increased life expectancy- more people living to old age

•Modern health services

• Trauma- injuries and accidents- domestic, RTA and industrial accidents and injuries,

• Neoplasm- cancers- breast, cervix, liver, prostate

• Congenital- Cleft lip/ palate, heart defect, club foot

• Nutrition – marasmus, kwashiokor, obesity, caries

• Endocrine – thyrotoxicosis, Cushings’ syndrome

• Degenerative- hypertension, arthritis, Coronary heart disease

• Allergic- Asthma

• Metabolic-Diabetes mellitus

• Mental- substance abuse, depression

• Intoxication- poisoning , alcohol

Classification

Major NCDs in Nigeria include:

•Hypertension

•Diabetes Mellitus

•Cancers

•Coronary Heart Disease

•Stroke

•Sickle Cell Disease

•G6PD Deficiency

•Road traffic injuries and violence

•Alcoholism and Substance Abuse etc

Burden of NCDs• 20.8M Nigerians ≥20 yrs hypertensive( Prevalence of about 28%)Hypertension is more in urban than rural

• Prevalence of diabetes from the general population is estimated at 2.8%. Higher in the urban than rural areas.

• About 150,000 - 200,000 babies are born each year in Nigeria with SCD

• More than half die before their fifth birthday, 90% before attaining adulthood if poorly managed in childhood.

•0.1M new cases of cancer diagnosed yearly

•6M Nigerians are asthmatic (mostly children)

•7000 Nigerians die from RT Crashes and from 26,000 injuries

Generally,1. Are permanent

2. Are caused by non-reversible pathological alteration

3. Leave residual disability

4. Patients require rehabilitation

5. Require long period of supervision, observation and care

6. Usually affects adults

Characteristics• Absence of known agent – orgs, silica and asbestos

• Multifactorial causation – absence of one to one cause but “risk factors”.

Risk factors- factors that are positively associated with the risk of development of a disease but are not sufficient to cause the disease

• Long latent period. Period between 1st exposure to suspected factor and eventual development of disease

• Hence difficult to link factor & disease, difficult to prevent.

4. Indefinite onset- Slow.

Distinction between disease and no-disease difficult

Common risk factors in NCDs• Smoking

• Overweight

• Excessive alcohol consumption

• Life style- low fibre diet, High fat, lack of physical exercise; and sexual behaviour

• Stress

• Family history

• Advancing age

• Unhealthy reproductive/sexual behaviour

• Occupational exposure

• Environmental factors- pollution, occupation hazards, nuclear weapons

Modifiable risk factors of NCD

•Lifestyle• Cigarette smoking

• Excessive alcohol

• Dietary patterns

• Physical activity

•Environmental• Occupational hazards

• Radiation

• Other pollutants

•Failure or inability to get preventive health services such as:

•Screening

•Early treatment

•Stress factors

•Recently identified aetiological factors

•Viral carcinogenesis

•HPV, Epstein barr virus, HIV, Hbag

Some general signals of Chronic disease

•Any sore that does not heal

• Lump or thickening in breast or elsewhere

•Unusual bleeding or discharge

•Any change in mole or swelling

•Persistent hoarseness or cough

•Persistent indigestion or difficulty

•Changes in bowel habits

•Chronic pain

NON COMMUNICABLE DISEASES ASSOCIATED WITH COMMUNICABLE DISEASES

1. RHEUMATIC HEART DISEASES: B HAEMOLYTIC STREPTOCOCCUS

2. CANCER OF THE CERVIX: HPV

3. KARPOSI SARCOMA: HIV

4. BURKITTS LYMPHOMA : EPSTEIN BAR VIRUS (EBV)

5. PRIMARY LIVERCELL CARCINOMA: AFLATOXIN B (FROM ASPERGILLUS FLAVUS)

6. GLOMERULONEPHRITIS: STREPTOCOCCUS SKIN INFECTION, QUARTAN MALARIA

NEPHROPATHY.

7. DIABETES MELLITUS: VIRAL PANCREATITIS

8. CARDIOMYOPATHY : DIPTHERIA MYOCARDITIS

Sources of data on NCDs•Hospital

•Ad-hoc survey

•National surveys

•Cancer registry• Collect and classify information on all

cancer cases in order to produce statistics on occurrence in defined population and to provide framework to help assess and control the impact of cancer on the community.

Prevention of NCDsMultiple Interventions

Primordial - Anti-smoking, alcohol, drug abuse

laws and legislation.

Primary- Health promotion, modification of risk

factors e.g. physical activity, relaxation & rest, good nutrition, emotional stability-avoidance of stress, health education, avoidance of exposure to harmful substances

Secondary- Screening, case finding, prompt

Treatment.

NCD PROGRAMME

• Established in 1989 by the FMOH

• To be the arrow head for response to prevent, early diagnosis, control and provide proper management guidelines.

• Benefits from technical support from an expert committee.

GOAL OF NCD CONTROL PROGRAMME

• To reverse the increasing prevalence of NCDs, through programmes that will prevent, provide early detection, control and management of NCDs in Nigeria

OBJECTIVE• To prevent and control NCD risk factors

• To prevent, control and provide management guidelines for the major NCDs and their complications in Nigeria.

Strategic Plan for NCDs

Is based on the following principles;

-Promotion of healthy life style

-Early detection

-Prevention and control

-Proper management and

-Prevention of complications

-Surveillance

STEPS TAKEN TO ADD IMPETUS TO THE PREVENTION AND CONTROL OF NCDS IN NIGERIA.

• Establishment of a national task force on NCDs prevention and control replacing the existing expert committee on NCDs established in 1989

• Flagging off of the National Stroke Prevention Programme in October 2013

STEPS TAKEN TO ADD IMPETUS TO THE PREVENTION AND CONTROL OF NCDS IN NIGERIA.

• Signing of the National Tobacco Control Bill into law on 26th May, 2015

• Development of the National Nutrition Guideline on Prevention and Control of NCDs and the National Guideline for the Control and Management of SCD

• Domestication of WHO Mental Health Gap Action Programme (mhGAP) and finalization of Mental Health Policy and Legislation.

National Strategic Plan of Action on

Prevention and Control of Non-Communicable Diseases

National NCD targets for 2025

• Premature mortality from NCDs: 25% relative reduction in overall mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases.

• Tobacco: 30% relative reduction in prevalence of current tobacco use

• Alcohol: 10% relative reduction in overall alcohol consumption (including hazardous and harmful drinking).

• Physical inactivity: 10% relative reduction in prevalence of insufficient physical activity.

National NCD targets for 2025 • Dietary salt intake: 30% relative reduction in mean adult

(aged ≥18) population intake of salt, with aim of achieving recommended level of <5g per day.

• Raised Blood Pressure: 25% relative reduction in Raised blood pressure prevalence of raised blood pressure.

• Diabetes, Obesity and Sickle Cell Disease: Halt the rise in the prevalence of diabetes, obesity and sickle cell disease.

National NCD targets for 2025 • Drug therapy to prevent heart attacks and strokes:

50% of eligible people receive drug therapy to prevent heart attacks and strokes, and counseling.

• Essential NCD medicines and basic technologies to detect and treat major NCDs:

80% availability of basic technologies and generic essential medicines required to treat major NCDs in both public and private facilities.