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Non-communicable diseases (NCDs) Non-communicable diseases


Non-communicable diseases (NCDs) Non-communicable diseases (NCDs) Is a disease which is not infectious. Such diseases may result from genetic or lifestyle factors. – PowerPoint PPT presentation

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Title: Non-communicable diseases (NCDs) Non-communicable diseases

Non-communicable diseases (NCDs)
Non-communicable diseases (NCDs)
  • Is a disease which is not infectious. Such
    diseases may result from genetic or lifestyle
  • A non-communicable disease is an illness that is
    caused by something other than a pathogen.
  • It might result from hereditary factors,
    improper diet, smoking, or other factors. Those
    resulting from lifestyle factors are sometimes
    called diseases of affluence.
  • Examples include hypertension, diabetes,
    cardiovascular disease, cancer, and mental health
    problems, asthma, atherosclerosis, allergy etc.
  • The non-communicable diseases are spread by
    heredity, surroundings and behavior.

  • Approximately, 17 million people die prematurely
    each year as a result of the global epidemic of
    chronic diseases
  • 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.
  • becoming dominant in all middle and low income
    countries and not limited to the effluent
  • 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
  • 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

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
  • Tobacco consumption is among the highest in the
  • 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
  • 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
  • No or weak national data is available on the
    overall incidence and prevalence ofNCDs.
  • In general we depend on mortality data to
    estimate the impacts of these diseases.
  • No classification by age or gender. No any
    information on disabilities resulting from any of
    the chronic diseases
  • The current system counts mainly the visits of
    the patients to PHC centers, which does not
    reflect the real prevalence and incidence.
  • 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
    decision making regarding prevention and

Some Continuing Challenges
  • Lack of national policies for NCD prevention and
  • Low resources - only 1/3 of countries have a
    budget line for NCD prevention control.
  • Lack of NCD surveillance systems
  • Fragmented and uncoordinated care
  • PHC capacity to deal with NCDs is poor

  • Cost Pressures
  • Disease burden, interventions, drugs
  • Quality of Care
  • Care teams, medical records, QIP financial
  • Prevention
  • Fragmentation, lack of protocols, lack of
    financial incentives/support
  • Poverty
  • Comprehensiveness
  • With policy/legislation support
  • Coordination
  • Information flows
  • Continuity
  • Organized Care
  • Communication
  • 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
  • Governance (improved performance)

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  • Obesity is a condition in which people have an
    excess of body fat.
  • 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
  • According to the National Institutes of Health,
    almost one-third of Americans are obese.
  • Obesity is growing problem across the globe.
  • Worldwide, more than 300 million adults are
    obese, according to (WHO).
  • 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
  • Coronary heart disease.
  • Cancer.
  • Diabetes.
  • Fatty liver disease.
  • Gallbladder disease.
  • High blood pressure..
  • Osteoarthritis.
  • Stroke.
  • Sleep apnea and other breathing problems.

  • 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. BMI was
    developed in the 19th century by the Belgian

  • 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.
  • BMI is calculated by dividing the subject's
    weight by the square of his or her height
  • BMI kg / m2

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Questions ??
  • The surgical literature breaks down "class III"
    obesity into further categories.
  • Any BMI gt 40 is severe obesity
  • A BMI of 40.049.9 is morbid obesity
  • A BMI of gt50 is super obese
  • Gabriel I Uwaifo (June 19, 2006). "Obesity".
    Retrieved on 2008-09-29.

  • Cancer
  • 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).

  • Cancer may affect people at all ages, even
    fetuses, but the risk for most varieties
    increases with age.
  • Cancer causes about 13 of all deaths.
  • According to the American Cancer Society, 7.6
    million people died from cancer in the world
    during 2007.

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2006 Estimated US Cancer Deaths
26 Lung bronchus 15 Breast 10 Colon
rectum 6 Pancreas 6 Ovary
4 Leukemia 3 Non-Hodgkin
lymphoma 3 Uterine corpus 2 Multiple
myeloma 2 Brain/ONS All other sites
Lung bronchus 31 Colon rectum 10 Prostate 9
Pancreas 6 Leukemia 4 Liver
intrahepatic 4bile duct Esophagus 4 Non-Hodgki
n 3 lymphoma
Urinary bladder 3 Kidney 3 All other sites
ONSOther nervous system. Source American Cancer
Society, 2006.
Hypertension The Silent killer
DefinitionHypertension is high blood pressure.
Blood pressure is the force of blood pushing
against the walls of arteries as it flows through
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
  • Non-modifiable
  • Age
  • Sex/gender
  • Heredity
  • Ethnicity/race
  • Modifiable
  • Body weight
  • Sodium chloride intake
  • Alcohol intake
  • Physical activity
  • Psychosocial factors
  • Socio-economic status
  • Hormonal contraceptives

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. 

Kearney PM et al. Lancet 2005 365217-223.
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 )

Hypertension affects 65 million adults in the
United States. The prevalence of
hypertension is higher at the older ages.

In PalestineIn 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.
Population pyramid for 2004
  • Total population 3,638,000 (WB 2,300,000/ GS

( Demographic Indicators, 2004 ,MOH)
  • 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

Cardiovascular Disease
  • 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.

Introduction, cont.
  • 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

  • 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
  • Non-modifiable Risk Factors
  • Age
  • Gender, men under the age 64 are much more likely
    to die of coronary heart disease than women,
    although anyone can die from it.
  • Genetic factors/Family history of cardiovascular
  • Race (or ethnicity), Studies show that blacks are
    twice as likely to develop high blood pressure as

Risk factors, cont.
  • Environment, your chances can increase because of
    areas with a lot of smog or other form of air
    pollution, including passive smoking.
  • Modifiable Risk Factors
  • cigarette smoking, high cholesterol and high
  • Pressure, lack of exercise, diabetes, obesity,
  • certain infections and inflammation, estrogens,
  • androgens, and certain psychosocial factors.

Risk factors for CVD in Palestine
  • There is little published information on the
    cardiovascular disease risk factors of
    Palestinian population.
  • 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 34, elevated cholesterol level 33,
    smoking 29, low HDL 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
  • The result of previous studies seems to be that
    most of the identified CHD risk factors could be
  • These results may highlight the problem as a
    public in nature that need community-based
    intervention programs integrated to health
    education programs.

  • According to these result greater attention to
    primary prevention is needed.
  • 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

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.
Statistics, cont
  • 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)

Percentage breakdown of deaths from
cardiovascular diseases
Statistics, cont
  • 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.

Statistics, cont
  • 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

Statistics, cont
  • 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

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).
Statistics, cont
  • Cardiovascular mortalities are ranking as
  • 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
  • Ischaemic heart disease constitutes 37.5 of
    cardiovascular diseases with a rate of 35.9 per
    100,000 population

Statistics, cont
  • Cerebrovascular disease constitutes 24.4 of CVDs
    with a rate of 23.4 per 100,000 population.
  • Hypertensive disease constitutes 17.4 of
    cardiovascular diseases with a rate of 16.6 per
    100,000 population.
  • Other heart diseases constitutes 17.4 of
    cardiovascular diseases with a rate of 16.7 per
    100,000 population.

Mortality rate of all CVD in Palestine,2005 (per
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

Glucose Tolerance Categories
2-hr PG on OGTT
Diabetes Mellitus
Diabetes Mellitus
?100 and lt126
?140 and lt200
The Expert Committee on the Diagnosis and
Classification of Diabetes Mellitus. Diabetes
Care. 200225(suppl)S5
Etiologic Classification of Diabetes Mellitus
Adapted from The Expert Committee on the
Diagnosis and Classification of Diabetes
Mellitus. Diabetes Care. 1997201183-1197.
Complications of Diabetes
  • Brain
  • Cerebrovascular disease
  • Transient ischemic attack
  • Cerebrovascular accident
  • Cognitive impairment

Eye Retinopathy Cataracts Glaucoma
  • Heart
  • Coronary artery disease
  • Coronary syndrome
  • Myocardial infarction
  • Congestive heart failure
  • Kidney
  • Nephropathy
  • Microalbuminuria
  • Gross albuminuria
  • Kidney failure
  • Extremities
  • Peripheral vascular disease
  • Ulceration
  • Gangrene
  • Amputation
  • 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."

2003-2030 (millions)
World 2003 194 million 2030 366
million Increase 75
  • 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.
  • Prevalence of Diabetes mellitus among population
    above 20 years in 2005 was 11.(WHO,2006)
  • Diabetes is in the top 10, and perhaps the top 5,
    of the most significant diseases in the developed
    world. (Wikipedia)

  • 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).
  • 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
  • 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.
  • In 2005, an estimated 1.1 million people died
    from diabetes.
  • Almost 80 of diabetes deaths occur in low and
    middle-income countries.

  • 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.
  • Worldwide, 3.2 million deaths are attributable to
    diabetes every year.
  • One in 20 deaths is attributable to diabetes
    8,700 deaths every day six deaths every minute.

  • At least one in ten deaths among adults between
    35 and 64 years old is attributable to diabetes.
  • Three-quarters of the deaths among people with
    diabetes aged under 35 years are due to their
  • 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.

  • 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.

Estimated number of adults with diabetes by
age-group in the world
Estimated number of adults with diabetes by
age-group in developed courtiers
Estimated number of adults with diabetes by
age-group in developing courtiers
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
  • 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).

  • 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)

Prevalence rates of diabetes and hypertension
among registered Population 40 years and above by
Field, 2005
New cases of Diabetes mellitus in West Bank
  • In 2005, out of total 2,741 new reported cases of
    diabetes in the West Bank diabetic clinics, out
    of them 28.2 was among age group of (55-64),
    41.0 among age group of 35-54 years, 6.3 among
    age less than 35 years, 24.4 among age 65 years
    and over.

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Distribution of diabetic (type II) cases by
management in the West Bank health clinic
  • 1. About 28.6 of diabetics cases were managed
    by insulin treatment.
  • 2. About 5.0 were treated with a combined
    therapy (insulin and OHA).
  • 3. About 64.7 of diabetics' cases were managed
    by tablets.
  • 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).

Disease-specific mortality rates among reported
Mortality of diabetes mellitus
  • 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.

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

Prevention of effects combination approach
  • Increased exercise
  • Decreases need for insulin
  • Reduce calorie intake
  • Improves insulin sensitivity
  • Weight reduction
  • Improves insulin action

Triad of Treatment
  • Diet
  • Medication
  • Oral hypoglycemics
  • Insulins
  • Exercise

  • Lower calorie
  • Fewer foods of high glycemic index
  • Spread meals evenly

Diabetic Meal Plan Using the Food Guide Pyramid
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Anti-Diabetic medications
  • Oral hypoglycemic agents
  • Sulfonylureas
  • Thiazolidinediones
  • Biguanides
  • Alpha-glucosidase inhibitors
  • D-phenylalinine derivatives
  • Insulins