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Tropenklinik, Tuebingen-Germany
EPN FORUM 2016
Plenary 2
General Overview of epidemiology and priority Non-Communicable
Diseases (NCDs) in Church Health Institutions (CHIs)
MBChB, MSc Clinical Epidemiology
Chidzewere Nzou
Programme Manager Zimbabwe Association of Church related Hospitals (ZACH)Email: [email protected]
Presentation Outline…
1. Definition of Non-Communicable Disease (NCD) 2. Approaches: Medicine vs Epidemiology
3. Risk factors and priority NCDs in CHIs
4. Global NCDs burden and measurements
Definition of Non-
Communicable Disease (NCD)
PART ONE
A disease that has a prolonged course, that does not resolve spontaneously, and for which a complete cure is rarely achieved
(McKenna, et al, 1998)N.B Do not result from an (acute) infectious process and hence are ‘not communicable’
Extended Definition:
In some definitions, NCDs also include:• chronic mental diseases and
• injuries, which have an acute onset, but may be followed by prolonged
convalescence and impaired function.
Characteristics of NCDs
●Multiple risk factors●Complex etiology (causes)●Long latency period ●Non-contagious origin (non-communicable)●Prolonged course of illness●Functional impairment or disability●Incurability
Approaches: Medicine vs Epidemiology
PART TWO
Risk Factors and Priority NCDs in CHIs
PART THREE
Risk Factor “An aspect of personal behavior or
lifestyle, an environmental exposure, or an inborn or inherited characteristic that
is associated with an increased occurrence of disease or other health-
related event or condition”
Cardiovascular Major modifiable risk factors High blood pressure Abnormal blood lipids Tobacco use Physical inactivity Obesity Unhealthy diet (salt) Diabetes
Other modifiable risk factors Low socioeconomic status Mental ill health (depression) Psychosocial stress Heavy alcohol use Use of certain medication Lipoprotein(a)
Non-modifiable risk factors Age Heredity or family history Gender Ethnicity or race
“Novel” risk factors Excess homocysteine in blood Inflammatory markers (C-reactive
protein) Abnormal blood coagulation (elevated
blood levels of fibrinogen)
Diabetes Major modifiable Risk Factors- Unhealthy diets- Physical Inactivity- Obesity or Overweight- High Blood Pressure- High Cholesterol
Other Modifiable Risk Factors- Low socioeconomic status- Heavy alcohol use- Psychological stress- High consumption of sugar-
sweetened beverages- Low consumption of fiber
Non-modifiable Risk Factors- Increased age- Family history/genetics- Race- Distribution of fat
Other Risk Factors- Low birth weight- Presence of autoantibodies
Cancers
Cancer type Risk FactorsCervical Cancer • Human papilloma virus infection (HPV)
• Smoking• Immune Deficiencies• No access to PAP screening• Family history of cervical cancer
Lung Cancer • Smoking pipes or cigars now or in the past• Second-hand smoke• Radiation therapy to the breast or chest• Being exposed to 1) asbestos 2) radon 3) chromium 4)
nickel 5) arsenic 6) soot or 7) tar• Air pollution
Cancer type Risk FactorsBreast Cancer • Hormone therapies, Weight, physical activity, Genetics or
family history• Age is the most reliable risk factor
‒ Risk increases with age
Prostate Cancer • age , obesity, weight gain
Liver cancer • Chronic hepatitis infections and Cirrhosis• Diabetes• Heavy alcohol consumption• Obesity
Cancer type Risk FactorsColorectal cancer ‒ Aging and Black race
‒ Unhealthy diet and low exercise‒ Diabetes‒ Family history of colorectal cancer
Stomach Cancer • Smoking • Family history of stomach cancer• Helicobacter pylori infections and ulcers or polyps• Diet
‒ High salt foods ‒ smoked foods ‒ pickled foods
Cancer Pictures
Chronic respiratory diseases
Genes
Infections
Socio-economic status
Aging Populations
Priority NCDs and common Risk Factors
Global NCDs burden and
measurements
PART FOUR
Global Trends Causes of Deaths
0
5
10
15
20
25
30
2004 2015 2030 2004 2015 2030 2004 2015 2030
Dea
ths
(mill
ions
)
High income Middle income Low income
HIV, TB, malariaOther infectiousMat//peri/nutritional
CVD
Cancers
Other NCDs
Road traffic accidentsOther unintentionalIntentional injuries
27
Epidemiological Shift: A transition from predominance of infectious diseases to chronic, degenerative, or man-made diseases and relates
well to demographic shift
Global Health Observatory (GHO) http://www.who.int/gho/en/Provides data and analyses on global health priorities
• Noncommunicable diseases• Mortality/morbidity• Risk Factors• Country statistics and health data
Media centre fact sheets http://www.who.int/mediacentre/factsheets/en/
• Key facts• Symptoms• Risk factors• Burden of disease
Incidence Rate- The development of new cases of a disease that occur during a specified period of time in previously disease-free or condition-free (“at risk”) individuals per 100,000 people
Cumulative incidence- PROPORTION of individuals who become diseased during a specified period of time Range: 0 to 1.0
Prevalence- The number of existing cases divided by the population count. Measured at a point in time rather than over some intervalTypically shown as a percentageMortality/Crude mortality- Number of deaths in a given time or place
Measurements of disease burden
Years of life lost (YLL) Measures the years of life lost due to premature mortality
Years of life with disability (YLD)Measures years of healthy life lost due to living in states of less than full health
Disability-Adjusted Life Year (DALY)Represents the total number of years lost to illness, disability (health utility), or premature death within a given population
Quality-Adjusted Life Year (QALY)Gives us an idea of how many extra months or years of life of reasonable quality a person might gain as result of treatment
Example- DALYs
Example Mortality DALYS
%1. High blood pressure 12.82. Tobacco use 8.73. High blood glucose 5.84. Physical inactivity 5.55. Overweight and obesity 4.86. High cholesterol 4.57. Unsafe sex 4.08. Alcohol use 3.89. Childhood underweight 3.810. Indoor smoke from solid fuels 3.3
59 million total global deaths in 2004
%1. Childhood underweight 7.82. High blood pressure 7.53. Unsafe sex 6.64. Unsafe water, sanitation, hygiene 6.15. High blood glucose 4.96. Indoor smoke from solid fuels 4.87. Tobacco use 3.98. Physical inactivity 3.89. Suboptimal breastfeeding 3.710. High cholesterol 3.3
1.5 billion total global DALYs in 2004
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