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EPIDEMIOLOGY OF NON COMMUNICABLE DISEASES
(NCDS)
DEFINITION OF NCD
Non-infectious & Non-
transmissible between
persons.
Mostly chronic diseases
of long duration & slow
progression which require
chronic care management.
Non communicable disease
CVDs
56%Cancer
25%
Resp.dis.
14%
DM
5%
The leading causes of NCD deaths in 2008
Non communicable disease
COMMON RISK FACTORS OF (NCDS)
Almost all NCDs have unknown cause, but they have some related RFs.
• Genetics
• Age
• Sex
• Race
Non
modifiable
• Smoking
• Alcoholism
• Unhealthy diet
• Physical inactivity
• Stress
• Environmental pollution
• Socio-economic conditions
Modifiable
WHO global status Report 2014: identified 5 important RFs for NCDs
in the top 10 leading risks to health.
↑ Blood pressure ↑ Cholesterol level Tobacco use
Alcohol
consumption
Overweight
Insufficient
physical activity.
Non communicable disease
Non communicable disease
REASONS OF THE INCREASING PREVALENCE OF NCDS
Demographic
transition
Epidemiologic
transition
Nutritional
Transition
Multi-factorial
nature of RFs
Migration
International
communication
Environmental
changes
Epidemiology of
NCDs differs
across countries
Epidemiology of
NCDs changing
all the time
Limited use of
scientific
progress in
management
Transition
Items
Demographic Epidemiologic Nutrition transition
Past
situations
-↑ Fertility
-↑ Mortality
↑ Infectious diseases ↑ Under nutrition
Interventi
ons
-Family planning
-Prevention & control
of infectious disease
-Env. sanitation
-Immunization
-Antibiotics
-Insecticides
Food production
Reducing Famines
Shift To -↓ Fertility
-↑ Life expectancy
-Aging
-↓ Infectious diseases
-↓ Mortality from
infectious diseases
↑ intake of saturated fat
& refined carb. + ↓
dietary fibers
Present
situation
NCDs associated with
aging.
NCDs predominates ↑ Obesity “↑ fat &
carb. intake +
Sedentary life”
• Compared to communicable diseases are difficult to identifying the specific cause-
effect relationship.
• RFs Multiplicity limit the opportunities to have specific intervention for prevention
& control.
• RFs are difficult to be controlled by medical technology (in communicable diseases ,
immunization & antibiotics are effective in prevention & control of diseases)
• RFs are related to genetic, environmental, culture and behavior which represent a
challenging issue to public health programs.
Multi-factorial nature of the risk factors for NCDs
Migration from low risk culture (e.g. rural areas) to high risk culture
(e.g. Urban areas ) follow the new life style → ↑NCDs risk.
Migration of population across different cultures
International
communication,
multinational business &
new food technologies →
new life-style & new food
products.
Communication through
the mass media∕ satellites∕
internet, overseas travel,
and international food
marketing → Introduction
of different concepts &
dietary pattern.
Adolescents & youth are
population segments who
are exposed to such
modernization in concepts
and behavior.
Early exposure →
development of large
cohort with health
problems during
adulthood & older age.
International communication
Environmental changes
Place
• Differences in prevalence of
RFs (genetic, environmental,
cultural & behavioral) across
countries → Limitations for
generalization.
• National Public health
specialists should have specific
surveillance system for different
NCDs (e.g. ↑ spicy food
→↑peptic ulcers & stomach
neoplasm).
Time
• Some countries succeeded in
improving pattern of some
NCDs (i.e. ↓ coronary heart
diseases by extensive anti-
smoking programs).
Epidemiology of NCDs differs across countries &changing all the time
Rapid & successful achievements in the science of risk detection, use
of medication & technologies to prevent & control NCDs.
However, in the developing countries high cost of NCDs prevention &
control programs is challenging.
Limited use of scientific progress in management of NCDs
3ry
Rehabilitate the complicated cases
2ry
Early detection of cases “Screening tests” Proper management
1ry
Health promotion & Health
education
Healthy life style
Enhancing the role of laws &
governance
PREVENTION OF NCD
Health promotion &
Health education
Adopting healthy
life style
• Balanced diet
• Physical activity
• Social activity
• Avoid SAD
“Smoking, Alcohol,
Drugs”
• Living in a healthy
environment
Enhancing the role of
laws & governance
• Improving access to
ttt
• Addressing social
impacts of illness (↑
taxes on tobacco,
Smoking bans in
public places,
Improving food
labeling).
HPN DM CVDs
Cancer cervix Cancer breast Cancer liver
Screening tests
Non communicable disease
Non communicable disease
Non communicable disease
Non communicable disease
EGYPT NATIONAL MULTISECTORAL ACTION PLAN FOR
PREVENTION & CONTROL OF NCD 2018-2022 (EGYPT MAP-NCD)
Framework Element Baseline Target 2021 Target 2025
Premature mortality from NCD 25% 15% relative reduction 20% relative reduction
Physical inactivity 32.1% 5% relative reduction 10% relative reduction
Salt/sodium intake 12.8 g/day 20% relative reduction
(10.0 g/ day)
10% relative reduction
(9.0 g/ day)
Tobacco use 24.4% 10% relative reduction
(22.0 %)
20% relative reduction
(20 %)
Raised blood Pressure 39% 15%relative reduction
(33%)
10 %relative reduction
(30%)
Diabetes & obesity 17.2% DM
31.3% Obesity
Halt the rise in DM & obesity
Drug therapy to prevent CVD *N/A % 10 % coverage 15% coverage
Essential NCDs medicines & basic
technologies to treat major NCDs
60% 70% availability 80 % availability
*As there is currently no available baseline data, the approach will be piloted in selected PHC settings.
Non communicable disease
Non communicable disease
Non communicable disease
Non communicable disease
Non communicable disease
HYPERTENSION
Hypertension “HPN” is one of the major risk factors for
CVDs.
TYPES & RF OF HYPERTENSION
1ry
No identified
cause (in most
cases).
Genetic or
familial
tendency.
Middle age
Males but equal
sex incidence
after menopause.
↑Cholesterol &
LDL or ↓ HDL.
Unhealthy
lifestyle
Smoking
Alcohol intake
Physical
inactivity
Stress,
↑ Salt, ↓ K
intake
Obesity
DM
2ry
Renal &
endocrine causes
Hormonal &
drug intake.
Non communicable disease
Non communicable disease
Non communicable disease
SCREENING TESTS FOR HPN
For screening purpose in the
community-based epidemiological
cross-sectional studies, these
standards could be used.
2 readings should be taken at least 5
minutes apart & average result
represents current Bl.Pr.
measurement
In the medical settings, diagnosis of
HPN depends on findings of Bl.Pr.
levels for >2 times few weeks apart.
COMPLICATIONS
Life style
modifications
(key management)
as ↓weight,
avoidance of
smoking & alcohol
intake, dietary salt &
fat restriction,
avoidance of stress
& keeping physical
exercise.
Early detection
Frequent blood
pressure
measurements after
age of 40 years.
Antihypertensive
drugs
If the lifestyle
modifications are
ineffective alone or
the level of HPN at
the start is so high.
Management of
causes of 2ry HPM.
Prevention
DIABETES MELLITUS
Non communicable disease
It is a common metabolic disorder of
impaired carbohydrate utilization by
the body due to insulin deficiency.
• Intermediate
conditions
between normality
& DM.
• At high risk of
progressing to
T2DM.
Impaired
Glucose
Tolerance
(IGT) &
Impaired
Fasting
Glycaemia
(IFG)
Non communicable disease
Age
• IDDM: young age
• NIDDM and glucose
intolerance: old age .
Sex
• Both sexes are equal.
• Males “stress”
• Females “pregnancy &
obesity”.
Race/ethnicity
• Native American, African
American, Latino, Asian
American, Pacific Islander
Obesity
• 80% of NIDDM patients
are obese.
Genetic or familial
tendency
• Children whom parents are
diabetic.
Autoimmunity
• To islet cells of pancreas.
Stress
• Trauma, operation,
depression, anxiety or
severe infection.
Pancreatic disorder
• Viral Infection (mumps,
coxsackie, enterovirus)
• Cancer pancreas
• Pancreatectomy.
Drugs
• Diuretics
• Corticosteroids
• Contraceptive pills.
Hormone
disturbance
• ↑ Thyroid & Growth
hormones “insulin
antagonistic action”.
RFs
Non-modifiable RF for T2DM Modifiable RF for T2DM
Non communicable disease
Non communicable disease
LABORATORY DIAGNOSIS OF DM
Non communicable disease
Non communicable disease
Non communicable disease
Non communicable disease
Non communicable disease
Non communicable disease
1ry prevention: Prevent predisposing factors. Dietary
education. Screening youth: children & adolescents <18 years of
age who are overweight or obese (BMI >85th percentile for age
and sex, weight for height >85th percentile, or weight >120% of
ideal for height), & have one or more additional RFs.
2ry prevention: Early case finding by screening tests for
glucose intolerance, or during check up for at risk groups.
Proper management of diagnosed cases: health education for
adherence to diet & ttt to prevent complications. Frequent check
up on retina & renal functions every 6 months & diet regimen.
Non communicable disease
HEALTH TECHNOLOGY & DIABETES MANAGEMENT
Continuous glucose monitoring (CGM) technology: helps improve
glycemic control for adults with T1DM starting at age 18.
DIABETES MANAGEMENT IN SPECIFIC GROUPS
Individualizing pharmacologic therapy for older adults to reduce the
risk of hypoglycemia, avoid overtreatment & simplify complex
regimens while maintaining personalized blood glucose targets.
New guideline recommends all
pregnant women with preexisting
T1DM or T2DM should consider
daily low-dose aspirin starting at the
end of the 1st trimester → ↓ the risk
of pre-eclampsia.
Non communicable disease
DEFINITION
It is an abnormal proliferation of cells in any organ in the body forming
mass or tumor. It invades the surrounding tissues and destroys them.
RISK FACTORS
• Age: >40 years.
• Sex: males.
• Residence: urban.
• Genetic & familial
susceptibility.
Demographic
or personal
factors
• Food.
• Smoking “30%”.
• Obesity.
• Alcohol.
Life style
• Human papilloma
virus.
• HCV, HBV &
bilharziasis.
• Helicobacter pylori.
Infectious
agents
• Drugs (OCPs) &
hormones (estrogen
replacement
therapy).
Drugs &
hormones
• Asbestos &
Pesticides
• Radiation
• Pollution
• Fungi (Aflatoxin in
grains & peanuts).
Environmental
& Occupational
risks
Non communicable disease
Non communicable disease
PREVENTION OF CANCER
1ry
• Stop smoking & alcohol
drinking
• Avoid food preservatives,
spicy foods
• Proper storage of grains
& peanuts
• Avoid hormone intake
expect under medial
supervision
• Vaccination for HBV.
• Early ttt of any disease
• Control of environmental
pollution
• Encourage breast feeding.
2ry
• Early diagnosis:screening
tests for at risk groups.
• Breast self-examination
• Cervical smear
• Sputum or X-ray for
cancer lung
• Tumor markers
• Biopsy for benign tumors.
3ry
• Rehabilitation
• Psychological assurance
• Palliative ttt.
BRONCHIAL ASTHMA
Non communicable disease
Non communicable disease
Non communicable disease
PRIMARY PREVENTION
Stop smoking
Control of
environmental pollution
Prevention of infection
Avoidance of allergic
foods
Pre-marital examination Physical exercise Early case detection. Skin tests
SECONDRY PREVENTION
TERTIARY PREVENTION
Breathing exercises
Psychological
support
Rehabilitation
ACCIDENTS
It is unexpected, unplanned event that produces injury, death, property
loss or damage.
• An increasing problem in both developed & developing countries.
• It is the 2nd leading cause of deaths in developing countries
Road traffic accidents Home accidents Occupational accidents Natural disaster
Birth injuries Sport injuries War accidents
ROAD TRAFFIC ACCIDENTS
Injuries such as laceration, contusions, bleeding, paralysis, fractures,
and amputation are common.
Death is commonly associated with road traffic accidents.
Egypt loses about 12 000 lives due to road traffic crashes every year. It
has a road traffic fatality rate of 42 deaths per 100 000 population.
Non communicable disease
Non communicable disease
Non communicable disease
Non communicable disease
RISK FACTORS
Road defects:
Narrow
Crowded
Inadequate
lightening
Lack of traffic
signs
Vehicle defects:
Old models
Bad maintenance
Variability in size.
Host factors
(driver):
Impaired alertness.
Inadequate
training.
Negligence of
wearing seat belts
or helmets.
Psychic upset.
Pedestrian:
Extreme of age
Impaired alertness
Negligence of
traffic signals
Obesity.
PREVENTION OF ROAD TRAFFIC ACCIDENTS
Roads:
Town planning.
Good lightening.
Sufficient traffic
signals.
Drivers:
Proper medical
examination
before license.
Sufficient
training.
Using seat belt,
wearing helmets.
Pedestrians:
Raising
awareness.
Vehicles:
Periodic
maintenance.
Strict legislations.
HOME ACCIDENTS
Burns
• Fire
• Boiling fluids
• Matches.
Falls
• On stairs
• Striking against
furniture
• Slippery floor.
Electric
shock
• Neglected
maintenance
• Exposed wire.
Wounds
• Sharp knives
• Pointed articles.
Chemical
poisoning
• Drugs
• Caustic soda
• Detergents.
Collapse of
old
buildings.
Animal bites
RISK FACTORS
Extreme of age. Epilepsy
Fainting
Loss of
consciousness.
Over
confidence in
repairing
electric
appliance.
Unsafe building
Bad
illumination
Slippery floor
or stairs.
PREVENTION
Storage of medications
& toxic substance in
closed places.
Close windows &
balcony
Matches, sharp knives
should be put in
hidden places.
Children should not
stay with mothers in
kitchens.
Proper arrangement of
furniture & using non
slippery tiles.
First aid must be
present in every house
Drying floor. Cover the electric plug
opening in the wall
OCCUPATIONAL ACCIDENTS
Accidents
occurring
during work
including acts
of violence
which result in
• a) fatal injury
• b) non-fatal injury.
At risk group
• Construction
workers,
agricultural
workers, miners,
industrial workers
etc…
Common body
parts injured
• Upper & lower
limbs, trunk, back,
head & neck.
Injury nature
• Cuts, lacerations,
contusions,
sprains, strains,
fractures, & burns.
Non communicable disease
Personal
factors
• Age
• Sex
• Lack of training
• Negligence of
wearing PPE
• Poor physical &
mental health
Environmental
factors
• Poor ventilation
• Poor illumination
• ↑ or ↓ temperature
• Noise
• Crowded places.
Machinery
factors
• Unshielded
• Exposed
electricity
• Poor maintenance
• Lack of safety
measures.
Working
conditions
• Prolonged
working hours &
inadequate rest
hours.
• Lack of training.
• Lack of
supervision.
• Poor
communication
INDICATORS OF OCCUPATIONAL ACCIDENTS
IMPACT OF ACCIDENTS ON WORKERS, INDUSTRY, AND ECONOMY
Impaired
health,
disability &
handicapping,
& death.
Psychic
problems
(PTSD).
↑ absenteeism
& ↓
productivity.
↑ expenses on
medical care,
rehabilitation
&
compensation.
PREVENTION OF OCCUPATIONAL ACCIDENTS
• Improving work environment.
• Good machinery design, safety & good maintenance.
• Health education of workers & proper training before work
• Prevention of fatigue & solving psychological troubles.
• ttt of any illness & good nutrition.
• Research studies.
1ry prevention
• 1st aid & emergency services for proper management of injuries at all work places.
2ry prevention
• Change the job of injured worker & proper training
• Artificial limb in amputation & special aids for handicapped workers.
3ry prevention
Non communicable disease
IMPORTANCE OF MENTAL HEALTH
Nearly ½ the world's populations are
affected by mental illness (WHO)
Impact on their self-esteem,
relationships & ability to function in
everyday life.
Everyday stress & even rapid
technological advances make most
people under marked stress
Good mental health can enhance
one’s life, while poor mental health
can prevent someone from living a
normal life.
Mental Health
• State of well-being in which the
individual:
• Realizes his own abilities,
• Cope with normal stresses of life,
• Can work productively
• Able to make a contribution to
community.
Mental Illness
• Any disease or conditions that
affect way a person
• Thinks,
• Feels,
• Behaves
• Ability to relate to others & to
surroundings
CRITERIA OF INDIVIDUALS WITH GOOD MENTAL HEALTH
Emotional
balance.
Social
adjustment.
Perceiving
things the way
they are.
Achievements
consistent
with the
individual's
abilities &
opportunities.
RISK FACTORS OF MENTAL DISORDERS
Sex Infections Genetic predisposition Age
Toxic
substances
Environmental
exposure
Homeless
Family problems
& loneliness
Malnutrition
 ↓ Iodine during pregnancy & ↓ O2 at birth, injuries & early childhood brain
infections → MR.
 Nutritional deficiencies “PEM” → MR.
 Depression interacts with CVDs & vice versa.
 Anxiety, depression & substance abuse can also complicate existing physical
disorders.
INTERACTION BETWEEN PHYSICAL & MENTAL HEALTH PROBLEMS
Schizophrenia
Psychosis &
depression
Behavioral disorders as
maladjustment & absenteeism.
Psychopathic disorders:
aggressive antisocial acts
Impaired
intelligence
TYPESOFMENTALDISORDERS
 Mental illness & poor mental health are public problems
 Great impact on:
THE IMPACT OF MENTAL DISORDERS
Individuals
• Distressing symptoms.
• Unable to participate in
work & leisure.
• Poor QoL: stigma &
discrimination.
Family
• Economic burden
• Disruption of house hold
routine & restricted
social activities.
• Lost work & social
opportunities.
Community
• Cost of providing care.
• Loss of productivity.
• Legal problems including
violence.
2ry
3ry
1ry
Prevention of Mental Illness
PRIMARY PREVENTION
Mental health
promotion
• Mental health educational
programs.
Genetic counseling,
antenatal & natal care
• Ensure normal fetal
development.
Public health-related
factors
• Education, employment,
social well-being
• Availability of suitable
food & housing
PRIMARY PREVENTION
Raising public awareness
• Patients need ttt & kind care.
Awareness of psychological
development
• Development of human
being's cognitive, emotional,
intellectual & social
capabilities.
Life skills education &
training
• Interpersonal communication
skills
• Decision-making & critical
thinking skills
• Stress management.
• Screening: Early
detection.
• Early diagnosis.
Detection of mental
disorders/illness in PHC
• Complete psychiatric
assessment.
• Counseling,
psychotherapy &
medical ttt.
• Admission to
psychiatric
word/hospital.
Proper management and/or
referral to a psychiatrist
• Wars, disasters &
crisis.
• Social support
improves the course
of the disease & ↓ its
duration & intensity
& enhances rapid
recovery
Crisis intervention
Intervention undertaken to reduce complications & all specific ttt.
SECONDARY PREVENTION
Needy/disabled
group
• ↑ Self-esteem & confidence.
• ↑ Opportunities for physical & socio-economic integration.
Family &
Community
•↑ Society understanding of causes of disabilities & abilities “Public
information campaigns →↓Stigmatization”.
•Communicate to parents about disabilities of their disabled children.
•Providing facilities/ services-day care centers & counseling sites to families &
Improve physical accessibility to public places.
•Create incentives for employers to hire disabled people.
•Training HCWs about their needs & Improving approach toward them.
Interventions that ↓ disability & all forms of rehabilitation + prevention of relapses of illness.
The integration of needy groups in the society is needed.
TERTIARY PREVENTION
MENTAL HEALTH PROGRAM IN EGYPT:
In Egypt the national mental health program focuses on:
Decentralization of MH care
& community care in
different governorates.
Inclusion of mental health in
PHC.
Training of family doctors to
deal with main mental
disorders.
Awareness-raising among
public regarding recognition
of mental disorders &
methods of referral.
The new policy may ↓ no. of psychiatric inpatients.
After-care services are still limited because of the poor understanding of most
people
SUBSTANCE ABUSE
Non communicable disease
Substance abuse “drug abuse”
• Any use of non prescribed, non controlled substances or drugs without medical
reason.
Drug Dependence
• State of psychic or physical dependence (or both) on a drug occurring after periodic or
continuous administration of that drug.
Tolerance
• Need for increasing the dose of a drug to reach the original effect of it.
Psycho Active Drugs
• Exogenous substances that affect CNS for calming, energizing or pleasurable.
• Excessive use of these drugs leads to tolerance.
Addicted Person
• Person who is unable to free himself from a harmful habit or he is unable to stop that
habit.
Non communicable disease
 In Egypt, drug abuse is considered one of the most serious public health
problems, especially among the young people at working ages.
 In Middle Eastern Arab countries, there is scarce information on mental
health issues, including drug dependence. This is related to the context of
the conservative nature of these societies that reject disclosing about drug
intake as well as to stigmatization.
Magnitude of the problem
Non communicable disease
Narcotics
• Morphine, Heroin & Codeine
• Strong psychic dependence & early physical
dependence & tolerance.
• Euphoria, ↓pain perception, nausea, constipation,
RC depression & visual disturbance.
Depressant
• Alcohol & Barbiturates.
• Psychic dependence, sedation, hypnosis,
anesthesia, muscle relaxation & sleep
Stimulants
• Amphetamine & Cocaine.
• Excitatory for CNS, alertness, euphoria,
motor activity, depression of appetite & large
doses cause convulsions
Hallucinogens
• LSD & Mascaline
• Distort perception of time & distance, induce
delusions & hallucination.
• Alter mood & may cause psychotic episodes
Cannabis
• Hashish & Marijuana & Bango.
• Affect cognition, memory & mood
• Deterioration of self perception & sensation of
time
TYPES OF PSYCHO ACTIVE DRUGS
Non communicable disease
Risk factors of drug addiction
Drug pharmacological
effects, “highly
addictive drug”.
Availability & easy
accessibility of drugs.
Gender.
Psychic & neurological
illness.
Family history of
addiction.
Lack of family
involvement.
Anxiety, depression and
loneliness.
Peer pressure.
Non communicable disease
IMPACTS OF DRUG ABUSE
Health problems &
Communicable disease
“HIV, HBV”.
↑ Accidents.
Unconsciousness, coma &
sudden death.
↑ Crime & Violence &
Suicide.
Family problems.
↓School performance &
motivation.
↓ Work performance + ↑
Absenteeism
Financial problems
PATTERN OF SUBSTANCE ABUSE IN EGYPT
• Cannabis, Opium, Hypnoseditives, Heroin, and Cocaine.
1980s
• Cannabis, Alcoholic beverages, Synthetic psychoactive drug.
1990s
• Cannabis became prevalent in the form of Bango “leaves of Cannabis sativa”.
• This plant is increasingly widely cultivated in Egypt, especially in Sinai Peninsula.
2nd half of the 1990s
• Tramadol “Scheduled drug”, milder synthetic opioid painkiller similar to morphine.
• Easily accessible at cheap costs from the black market
• 30% of males “14-30 years” “Students, laborers & professionals” use it regularly “For
Premature ejaculation & for extended orgasm & increase sexual pleasure”
Since 2007
70 % of admissions to the addiction wing of Cairo’s massive Qasr el-Aini hospital
were linked to tramadol in 2014 alone.
PREVENTION OF DRUG DEPENDENCE
2ry
3ry
1ry
PRIMARY PREVENTION
Empower laws
& legislations.
Health
education.
Encourage
youth for
physical
exercise & safe
recreation
activities.
Suitable
management of
family & social
problems.
Parental
supervision &
control
influence of
peers.
Non communicable disease
SECONDARY PREVENTION
Early diagnosis &
continuous
supervision.
Hospitalization of
severe cases.
Hot line service “rapid
management &
confidential service”.
Follow up of
recovered cases.
TERTIARY PREVENTION
Rehabilitation of addicts, find suitable jobs & no community
stigma
Non communicable disease

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Non communicable disease

  • 1. EPIDEMIOLOGY OF NON COMMUNICABLE DISEASES (NCDS)
  • 2. DEFINITION OF NCD Non-infectious & Non- transmissible between persons. Mostly chronic diseases of long duration & slow progression which require chronic care management.
  • 6. COMMON RISK FACTORS OF (NCDS) Almost all NCDs have unknown cause, but they have some related RFs. • Genetics • Age • Sex • Race Non modifiable • Smoking • Alcoholism • Unhealthy diet • Physical inactivity • Stress • Environmental pollution • Socio-economic conditions Modifiable
  • 7. WHO global status Report 2014: identified 5 important RFs for NCDs in the top 10 leading risks to health. ↑ Blood pressure ↑ Cholesterol level Tobacco use Alcohol consumption Overweight Insufficient physical activity.
  • 10. REASONS OF THE INCREASING PREVALENCE OF NCDS Demographic transition Epidemiologic transition Nutritional Transition Multi-factorial nature of RFs Migration International communication Environmental changes Epidemiology of NCDs differs across countries Epidemiology of NCDs changing all the time Limited use of scientific progress in management
  • 11. Transition Items Demographic Epidemiologic Nutrition transition Past situations -↑ Fertility -↑ Mortality ↑ Infectious diseases ↑ Under nutrition Interventi ons -Family planning -Prevention & control of infectious disease -Env. sanitation -Immunization -Antibiotics -Insecticides Food production Reducing Famines Shift To -↓ Fertility -↑ Life expectancy -Aging -↓ Infectious diseases -↓ Mortality from infectious diseases ↑ intake of saturated fat & refined carb. + ↓ dietary fibers Present situation NCDs associated with aging. NCDs predominates ↑ Obesity “↑ fat & carb. intake + Sedentary life”
  • 12. • Compared to communicable diseases are difficult to identifying the specific cause- effect relationship. • RFs Multiplicity limit the opportunities to have specific intervention for prevention & control. • RFs are difficult to be controlled by medical technology (in communicable diseases , immunization & antibiotics are effective in prevention & control of diseases) • RFs are related to genetic, environmental, culture and behavior which represent a challenging issue to public health programs. Multi-factorial nature of the risk factors for NCDs
  • 13. Migration from low risk culture (e.g. rural areas) to high risk culture (e.g. Urban areas ) follow the new life style → ↑NCDs risk. Migration of population across different cultures
  • 14. International communication, multinational business & new food technologies → new life-style & new food products. Communication through the mass media∕ satellites∕ internet, overseas travel, and international food marketing → Introduction of different concepts & dietary pattern. Adolescents & youth are population segments who are exposed to such modernization in concepts and behavior. Early exposure → development of large cohort with health problems during adulthood & older age. International communication
  • 16. Place • Differences in prevalence of RFs (genetic, environmental, cultural & behavioral) across countries → Limitations for generalization. • National Public health specialists should have specific surveillance system for different NCDs (e.g. ↑ spicy food →↑peptic ulcers & stomach neoplasm). Time • Some countries succeeded in improving pattern of some NCDs (i.e. ↓ coronary heart diseases by extensive anti- smoking programs). Epidemiology of NCDs differs across countries &changing all the time
  • 17. Rapid & successful achievements in the science of risk detection, use of medication & technologies to prevent & control NCDs. However, in the developing countries high cost of NCDs prevention & control programs is challenging. Limited use of scientific progress in management of NCDs
  • 18. 3ry Rehabilitate the complicated cases 2ry Early detection of cases “Screening tests” Proper management 1ry Health promotion & Health education Healthy life style Enhancing the role of laws & governance PREVENTION OF NCD
  • 19. Health promotion & Health education Adopting healthy life style • Balanced diet • Physical activity • Social activity • Avoid SAD “Smoking, Alcohol, Drugs” • Living in a healthy environment Enhancing the role of laws & governance • Improving access to ttt • Addressing social impacts of illness (↑ taxes on tobacco, Smoking bans in public places, Improving food labeling).
  • 20. HPN DM CVDs Cancer cervix Cancer breast Cancer liver Screening tests
  • 25. EGYPT NATIONAL MULTISECTORAL ACTION PLAN FOR PREVENTION & CONTROL OF NCD 2018-2022 (EGYPT MAP-NCD) Framework Element Baseline Target 2021 Target 2025 Premature mortality from NCD 25% 15% relative reduction 20% relative reduction Physical inactivity 32.1% 5% relative reduction 10% relative reduction Salt/sodium intake 12.8 g/day 20% relative reduction (10.0 g/ day) 10% relative reduction (9.0 g/ day) Tobacco use 24.4% 10% relative reduction (22.0 %) 20% relative reduction (20 %) Raised blood Pressure 39% 15%relative reduction (33%) 10 %relative reduction (30%) Diabetes & obesity 17.2% DM 31.3% Obesity Halt the rise in DM & obesity Drug therapy to prevent CVD *N/A % 10 % coverage 15% coverage Essential NCDs medicines & basic technologies to treat major NCDs 60% 70% availability 80 % availability *As there is currently no available baseline data, the approach will be piloted in selected PHC settings.
  • 32. Hypertension “HPN” is one of the major risk factors for CVDs.
  • 33. TYPES & RF OF HYPERTENSION 1ry No identified cause (in most cases). Genetic or familial tendency. Middle age Males but equal sex incidence after menopause. ↑Cholesterol & LDL or ↓ HDL. Unhealthy lifestyle Smoking Alcohol intake Physical inactivity Stress, ↑ Salt, ↓ K intake Obesity DM 2ry Renal & endocrine causes Hormonal & drug intake.
  • 37. SCREENING TESTS FOR HPN For screening purpose in the community-based epidemiological cross-sectional studies, these standards could be used. 2 readings should be taken at least 5 minutes apart & average result represents current Bl.Pr. measurement In the medical settings, diagnosis of HPN depends on findings of Bl.Pr. levels for >2 times few weeks apart.
  • 39. Life style modifications (key management) as ↓weight, avoidance of smoking & alcohol intake, dietary salt & fat restriction, avoidance of stress & keeping physical exercise. Early detection Frequent blood pressure measurements after age of 40 years. Antihypertensive drugs If the lifestyle modifications are ineffective alone or the level of HPN at the start is so high. Management of causes of 2ry HPM. Prevention
  • 42. It is a common metabolic disorder of impaired carbohydrate utilization by the body due to insulin deficiency. • Intermediate conditions between normality & DM. • At high risk of progressing to T2DM. Impaired Glucose Tolerance (IGT) & Impaired Fasting Glycaemia (IFG)
  • 44. Age • IDDM: young age • NIDDM and glucose intolerance: old age . Sex • Both sexes are equal. • Males “stress” • Females “pregnancy & obesity”. Race/ethnicity • Native American, African American, Latino, Asian American, Pacific Islander Obesity • 80% of NIDDM patients are obese. Genetic or familial tendency • Children whom parents are diabetic. Autoimmunity • To islet cells of pancreas. Stress • Trauma, operation, depression, anxiety or severe infection. Pancreatic disorder • Viral Infection (mumps, coxsackie, enterovirus) • Cancer pancreas • Pancreatectomy. Drugs • Diuretics • Corticosteroids • Contraceptive pills. Hormone disturbance • ↑ Thyroid & Growth hormones “insulin antagonistic action”. RFs
  • 45. Non-modifiable RF for T2DM Modifiable RF for T2DM
  • 55. 1ry prevention: Prevent predisposing factors. Dietary education. Screening youth: children & adolescents <18 years of age who are overweight or obese (BMI >85th percentile for age and sex, weight for height >85th percentile, or weight >120% of ideal for height), & have one or more additional RFs. 2ry prevention: Early case finding by screening tests for glucose intolerance, or during check up for at risk groups. Proper management of diagnosed cases: health education for adherence to diet & ttt to prevent complications. Frequent check up on retina & renal functions every 6 months & diet regimen.
  • 57. HEALTH TECHNOLOGY & DIABETES MANAGEMENT Continuous glucose monitoring (CGM) technology: helps improve glycemic control for adults with T1DM starting at age 18.
  • 58. DIABETES MANAGEMENT IN SPECIFIC GROUPS Individualizing pharmacologic therapy for older adults to reduce the risk of hypoglycemia, avoid overtreatment & simplify complex regimens while maintaining personalized blood glucose targets.
  • 59. New guideline recommends all pregnant women with preexisting T1DM or T2DM should consider daily low-dose aspirin starting at the end of the 1st trimester → ↓ the risk of pre-eclampsia.
  • 61. DEFINITION It is an abnormal proliferation of cells in any organ in the body forming mass or tumor. It invades the surrounding tissues and destroys them.
  • 62. RISK FACTORS • Age: >40 years. • Sex: males. • Residence: urban. • Genetic & familial susceptibility. Demographic or personal factors • Food. • Smoking “30%”. • Obesity. • Alcohol. Life style • Human papilloma virus. • HCV, HBV & bilharziasis. • Helicobacter pylori. Infectious agents • Drugs (OCPs) & hormones (estrogen replacement therapy). Drugs & hormones • Asbestos & Pesticides • Radiation • Pollution • Fungi (Aflatoxin in grains & peanuts). Environmental & Occupational risks
  • 65. PREVENTION OF CANCER 1ry • Stop smoking & alcohol drinking • Avoid food preservatives, spicy foods • Proper storage of grains & peanuts • Avoid hormone intake expect under medial supervision • Vaccination for HBV. • Early ttt of any disease • Control of environmental pollution • Encourage breast feeding. 2ry • Early diagnosis:screening tests for at risk groups. • Breast self-examination • Cervical smear • Sputum or X-ray for cancer lung • Tumor markers • Biopsy for benign tumors. 3ry • Rehabilitation • Psychological assurance • Palliative ttt.
  • 70. PRIMARY PREVENTION Stop smoking Control of environmental pollution Prevention of infection Avoidance of allergic foods Pre-marital examination Physical exercise Early case detection. Skin tests
  • 74. It is unexpected, unplanned event that produces injury, death, property loss or damage. • An increasing problem in both developed & developing countries. • It is the 2nd leading cause of deaths in developing countries Road traffic accidents Home accidents Occupational accidents Natural disaster Birth injuries Sport injuries War accidents
  • 75. ROAD TRAFFIC ACCIDENTS Injuries such as laceration, contusions, bleeding, paralysis, fractures, and amputation are common. Death is commonly associated with road traffic accidents. Egypt loses about 12 000 lives due to road traffic crashes every year. It has a road traffic fatality rate of 42 deaths per 100 000 population.
  • 80. RISK FACTORS Road defects: Narrow Crowded Inadequate lightening Lack of traffic signs Vehicle defects: Old models Bad maintenance Variability in size. Host factors (driver): Impaired alertness. Inadequate training. Negligence of wearing seat belts or helmets. Psychic upset. Pedestrian: Extreme of age Impaired alertness Negligence of traffic signals Obesity.
  • 81. PREVENTION OF ROAD TRAFFIC ACCIDENTS Roads: Town planning. Good lightening. Sufficient traffic signals. Drivers: Proper medical examination before license. Sufficient training. Using seat belt, wearing helmets. Pedestrians: Raising awareness. Vehicles: Periodic maintenance. Strict legislations.
  • 82. HOME ACCIDENTS Burns • Fire • Boiling fluids • Matches. Falls • On stairs • Striking against furniture • Slippery floor. Electric shock • Neglected maintenance • Exposed wire. Wounds • Sharp knives • Pointed articles. Chemical poisoning • Drugs • Caustic soda • Detergents. Collapse of old buildings. Animal bites
  • 83. RISK FACTORS Extreme of age. Epilepsy Fainting Loss of consciousness. Over confidence in repairing electric appliance. Unsafe building Bad illumination Slippery floor or stairs.
  • 84. PREVENTION Storage of medications & toxic substance in closed places. Close windows & balcony Matches, sharp knives should be put in hidden places. Children should not stay with mothers in kitchens. Proper arrangement of furniture & using non slippery tiles. First aid must be present in every house Drying floor. Cover the electric plug opening in the wall
  • 85. OCCUPATIONAL ACCIDENTS Accidents occurring during work including acts of violence which result in • a) fatal injury • b) non-fatal injury. At risk group • Construction workers, agricultural workers, miners, industrial workers etc… Common body parts injured • Upper & lower limbs, trunk, back, head & neck. Injury nature • Cuts, lacerations, contusions, sprains, strains, fractures, & burns.
  • 87. Personal factors • Age • Sex • Lack of training • Negligence of wearing PPE • Poor physical & mental health Environmental factors • Poor ventilation • Poor illumination • ↑ or ↓ temperature • Noise • Crowded places. Machinery factors • Unshielded • Exposed electricity • Poor maintenance • Lack of safety measures. Working conditions • Prolonged working hours & inadequate rest hours. • Lack of training. • Lack of supervision. • Poor communication
  • 89. IMPACT OF ACCIDENTS ON WORKERS, INDUSTRY, AND ECONOMY Impaired health, disability & handicapping, & death. Psychic problems (PTSD). ↑ absenteeism & ↓ productivity. ↑ expenses on medical care, rehabilitation & compensation.
  • 90. PREVENTION OF OCCUPATIONAL ACCIDENTS • Improving work environment. • Good machinery design, safety & good maintenance. • Health education of workers & proper training before work • Prevention of fatigue & solving psychological troubles. • ttt of any illness & good nutrition. • Research studies. 1ry prevention • 1st aid & emergency services for proper management of injuries at all work places. 2ry prevention • Change the job of injured worker & proper training • Artificial limb in amputation & special aids for handicapped workers. 3ry prevention
  • 92. IMPORTANCE OF MENTAL HEALTH Nearly ½ the world's populations are affected by mental illness (WHO) Impact on their self-esteem, relationships & ability to function in everyday life. Everyday stress & even rapid technological advances make most people under marked stress Good mental health can enhance one’s life, while poor mental health can prevent someone from living a normal life.
  • 93. Mental Health • State of well-being in which the individual: • Realizes his own abilities, • Cope with normal stresses of life, • Can work productively • Able to make a contribution to community. Mental Illness • Any disease or conditions that affect way a person • Thinks, • Feels, • Behaves • Ability to relate to others & to surroundings
  • 94. CRITERIA OF INDIVIDUALS WITH GOOD MENTAL HEALTH Emotional balance. Social adjustment. Perceiving things the way they are. Achievements consistent with the individual's abilities & opportunities.
  • 95. RISK FACTORS OF MENTAL DISORDERS Sex Infections Genetic predisposition Age
  • 97.  ↓ Iodine during pregnancy & ↓ O2 at birth, injuries & early childhood brain infections → MR.  Nutritional deficiencies “PEM” → MR.  Depression interacts with CVDs & vice versa.  Anxiety, depression & substance abuse can also complicate existing physical disorders. INTERACTION BETWEEN PHYSICAL & MENTAL HEALTH PROBLEMS
  • 98. Schizophrenia Psychosis & depression Behavioral disorders as maladjustment & absenteeism. Psychopathic disorders: aggressive antisocial acts Impaired intelligence TYPESOFMENTALDISORDERS
  • 99.  Mental illness & poor mental health are public problems  Great impact on: THE IMPACT OF MENTAL DISORDERS
  • 100. Individuals • Distressing symptoms. • Unable to participate in work & leisure. • Poor QoL: stigma & discrimination. Family • Economic burden • Disruption of house hold routine & restricted social activities. • Lost work & social opportunities. Community • Cost of providing care. • Loss of productivity. • Legal problems including violence.
  • 102. PRIMARY PREVENTION Mental health promotion • Mental health educational programs. Genetic counseling, antenatal & natal care • Ensure normal fetal development. Public health-related factors • Education, employment, social well-being • Availability of suitable food & housing
  • 103. PRIMARY PREVENTION Raising public awareness • Patients need ttt & kind care. Awareness of psychological development • Development of human being's cognitive, emotional, intellectual & social capabilities. Life skills education & training • Interpersonal communication skills • Decision-making & critical thinking skills • Stress management.
  • 104. • Screening: Early detection. • Early diagnosis. Detection of mental disorders/illness in PHC • Complete psychiatric assessment. • Counseling, psychotherapy & medical ttt. • Admission to psychiatric word/hospital. Proper management and/or referral to a psychiatrist • Wars, disasters & crisis. • Social support improves the course of the disease & ↓ its duration & intensity & enhances rapid recovery Crisis intervention Intervention undertaken to reduce complications & all specific ttt. SECONDARY PREVENTION
  • 105. Needy/disabled group • ↑ Self-esteem & confidence. • ↑ Opportunities for physical & socio-economic integration. Family & Community •↑ Society understanding of causes of disabilities & abilities “Public information campaigns →↓Stigmatization”. •Communicate to parents about disabilities of their disabled children. •Providing facilities/ services-day care centers & counseling sites to families & Improve physical accessibility to public places. •Create incentives for employers to hire disabled people. •Training HCWs about their needs & Improving approach toward them. Interventions that ↓ disability & all forms of rehabilitation + prevention of relapses of illness. The integration of needy groups in the society is needed. TERTIARY PREVENTION
  • 106. MENTAL HEALTH PROGRAM IN EGYPT: In Egypt the national mental health program focuses on: Decentralization of MH care & community care in different governorates. Inclusion of mental health in PHC. Training of family doctors to deal with main mental disorders. Awareness-raising among public regarding recognition of mental disorders & methods of referral. The new policy may ↓ no. of psychiatric inpatients. After-care services are still limited because of the poor understanding of most people
  • 109. Substance abuse “drug abuse” • Any use of non prescribed, non controlled substances or drugs without medical reason. Drug Dependence • State of psychic or physical dependence (or both) on a drug occurring after periodic or continuous administration of that drug. Tolerance • Need for increasing the dose of a drug to reach the original effect of it. Psycho Active Drugs • Exogenous substances that affect CNS for calming, energizing or pleasurable. • Excessive use of these drugs leads to tolerance. Addicted Person • Person who is unable to free himself from a harmful habit or he is unable to stop that habit.
  • 111.  In Egypt, drug abuse is considered one of the most serious public health problems, especially among the young people at working ages.  In Middle Eastern Arab countries, there is scarce information on mental health issues, including drug dependence. This is related to the context of the conservative nature of these societies that reject disclosing about drug intake as well as to stigmatization. Magnitude of the problem
  • 113. Narcotics • Morphine, Heroin & Codeine • Strong psychic dependence & early physical dependence & tolerance. • Euphoria, ↓pain perception, nausea, constipation, RC depression & visual disturbance. Depressant • Alcohol & Barbiturates. • Psychic dependence, sedation, hypnosis, anesthesia, muscle relaxation & sleep Stimulants • Amphetamine & Cocaine. • Excitatory for CNS, alertness, euphoria, motor activity, depression of appetite & large doses cause convulsions Hallucinogens • LSD & Mascaline • Distort perception of time & distance, induce delusions & hallucination. • Alter mood & may cause psychotic episodes Cannabis • Hashish & Marijuana & Bango. • Affect cognition, memory & mood • Deterioration of self perception & sensation of time TYPES OF PSYCHO ACTIVE DRUGS
  • 115. Risk factors of drug addiction Drug pharmacological effects, “highly addictive drug”. Availability & easy accessibility of drugs. Gender. Psychic & neurological illness. Family history of addiction. Lack of family involvement. Anxiety, depression and loneliness. Peer pressure.
  • 117. IMPACTS OF DRUG ABUSE Health problems & Communicable disease “HIV, HBV”. ↑ Accidents. Unconsciousness, coma & sudden death. ↑ Crime & Violence & Suicide. Family problems. ↓School performance & motivation. ↓ Work performance + ↑ Absenteeism Financial problems
  • 118. PATTERN OF SUBSTANCE ABUSE IN EGYPT • Cannabis, Opium, Hypnoseditives, Heroin, and Cocaine. 1980s • Cannabis, Alcoholic beverages, Synthetic psychoactive drug. 1990s • Cannabis became prevalent in the form of Bango “leaves of Cannabis sativa”. • This plant is increasingly widely cultivated in Egypt, especially in Sinai Peninsula. 2nd half of the 1990s • Tramadol “Scheduled drug”, milder synthetic opioid painkiller similar to morphine. • Easily accessible at cheap costs from the black market • 30% of males “14-30 years” “Students, laborers & professionals” use it regularly “For Premature ejaculation & for extended orgasm & increase sexual pleasure” Since 2007
  • 119. 70 % of admissions to the addiction wing of Cairo’s massive Qasr el-Aini hospital were linked to tramadol in 2014 alone.
  • 120. PREVENTION OF DRUG DEPENDENCE 2ry 3ry 1ry
  • 121. PRIMARY PREVENTION Empower laws & legislations. Health education. Encourage youth for physical exercise & safe recreation activities. Suitable management of family & social problems. Parental supervision & control influence of peers.
  • 123. SECONDARY PREVENTION Early diagnosis & continuous supervision. Hospitalization of severe cases. Hot line service “rapid management & confidential service”. Follow up of recovered cases.
  • 124. TERTIARY PREVENTION Rehabilitation of addicts, find suitable jobs & no community stigma

Notas del editor

  1. Although the precise cause of mental illness isn't known, certain factors may increase risk of developing mental health problems, including:
  2. Although the precise cause of mental illness isn't known, certain factors may increase risk of developing mental health problems, including:
  3. All efforts should be involved in the treatment and prevention of addiction. Support from all agencies, health and social, religion, educators and community leaders.