Non communicable disease

• 4 Major Non-Communicable Diseases (NCD)

  • Cardiovascular diseases
  • Cancer
  • Chronic Obstructive Pulmonary Disease
  • Diabetes mellitus

  
• Integrated community-based NCD prevention and control program aimed at preventing the 4 major NCD or chronic diseases or lifestyle-related disease
• Other NCD to be prevented and controlled

  • Mental disorders
  • Blindness
  • Renal disease
  • Programs for persons with disabilities
• Health Educator


  Essential tool to achieve community health, concerned with promoting health as well as reducing behavior induced diseases, aims to inform, motivate and guide the people into action
• Cardiovascular Diseases (CVD)


  • Diseases of the heart and blood vessels

  
• Hypertension (HPN) or High Blood Pressure


  Sustained elevation in mean arterial pressure, major risk factor for the development of other CVDs like Coronary Heart Disease or Stroke, not a single disease state but a disorder with many causes, a variety of symptoms and a range of responses to therapy
• Types of Hypertension


  • Primary Hypertension (no definite cause, attributed to atherosclerosis)
  • Secondary Hypertension (result from other diseases that leads to hypertension such as renal diseases)
• Risk Factors for Hypertension


  • Family History
  • Age
  • Race
  • High salt intake
  • Obesity
  • Excess alcohol consumption
  • Stress
• Prevention of Hypertension


  1. Encourage proper nutrition

  2. Smoking cessation

  3. Regular check-ups
• Coronary Artery Disease (CAD)


  Heart disease caused by impaired coronary blood flow, also known as Ischemic Heart Disease, can cause myocardial infarction (heart attack), arrhythmias, heart failure and sudden death, caused by atherosclerosis (thickening of the inside wall of the arteries due to deposition of fat-like substance)

  
• Risk Factors for Coronary Artery Disease


  • Family History
  • Age
  • Race
  • Sex
  • Elevated blood lipids (Low Density Lipoprotein)
  • Hypertension
  • Smoking
  • Diabetes Mellitus
  • Obesity
  • Stress

  
• Prevention of Coronary Artery Disease

  1. Regular exercises & physical activity

  2. Proper nutrition – limit salt intake, limit saturated fats

  3. Stop smoking

  4. Early diagnosis & prompt treatment
• Cerebrovascular Disease or Stroke


  Loss of alteration of bodily function that results from an insufficient supply of blood to some parts of the brain, if blood is obstructed for more than several minutes, injury to the brain cells becomes permanent and tissue dies in the affected region resulting in cerebral infarction, one of the leading causes of disability
• Types of Stroke


  • Thrombolytic stroke (usually occurs in atherosclerotic blood vessel commonly seen in older people)
  • Embolic stroke (caused by a clot that travels from somewhere else in the body, usually from the heart)
  • Hemorrhagic stroke (most fatal type of stroke, rupture of intracerebral blood vessel)
• Cancer


  Develops when cells in a part of the body begin to grow out of control, cancer cells continue to grow and divide even when there is no need to do so, they compete with normal cells for the blood supply and nutrients, metastasis occurs when cancer cells get into the bloodstream or lymph vessels and can travel to other parts of the body and begin to grow and replace normal cells

  
• Risk Factors for Cancer


  • Hereditary/family history
  • Carcinogens (chemical, environmental agent, radiation) - polycyclic hydrocarbon, benzopyrene, nitrosamines, radiation, viruses, aflatoxin

  
• Prevention of Cancer


  1. Smoking cessation

  2. Encourage proper nutrition (increase intake of dietary fibers, limit consumption of smoked, charcoal-broiled, salt cured foods)

  3. Drink alcohol beverages in moderation

  4. Control obesity

  5. Early diagnosis and prompt treatment
• Diabetes Mellitus


  Genetically and clinically heterogeneous group of metabolic disorder characterized by glucose intolerance with hyperglycemia present at time of diagnosis, depends on the type of diabetes, two predisposing factors include genetic predisposition and environment/lifestyle
• Types of Diabetes Mellitus

  • Type I - Insulin dependent Diabetes Mellitus (IDDM) (characterized by absolute lack of insulin due to damaged pancreas, dependent on insulin injections, genetic, environmental or maybe acquired)
  • Type II - Non-insulin Dependent Diabetes Mellitus (NIDDM) (more common, 90-95% of all person with obesity and diet, possible cause include impaired insulin secretion and increased hepatic glucose production, usually in older and overweight persons)
  • Gestational Diabetes (develops during pregnancy and may lead to type II DM)
• Risk Factors for Type II Diabetes Mellitus


  • Family history
  • Overweight and obesity
  • Sedentary lifestyle
  • Hypertension
• Complications of Diabetes Mellitus

  • Diabetic ketoacidosis
  • Hypoglycemia
  • Chronic renal disease
  • Blindness/retinopathy
  • Cardiovascular Disease/Stroke
  • Foot ulcers
• Prevention of Diabetes Mellitus

  1. Encourage proper nutrition

  2. Maintain body weight and prevent obesity

  3. Promote regular exercise

  4. Smoking cessation
• Screening for Diabetes Mellitus


  • Ask the patient (for adults 20 years and above) about family history of diabetes, polyuria, polydypsia, polyphagia, unexplained weight loss
  • Fasting blood sugar
  • 2 hours post prandial test
• Chronic Obstructive Pulmonary Disease (COPD)

  Major cause of chronic morbidity and mortality worldwide, 4th leading cause of mortality, characterized by air flow limitation that is not fully reversible, the airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases
• Causes and Risk Factors of COPD

  • Smoking (primary cause)
  • Chronic bronchitis
  • Emphysema
  • Age
• Primary Symptoms and Diagnosis of COPD

  • Cough
  • Sputum production
  • Dyspnea
• Complications of COPD


  • Respiratory failure
  • Cardiovascular disease
• Bronchial Asthma


  A chronic disease characterized by chronic inflammation and hyper responsiveness of airways, the episode is reversible spontaneously or by treatment, causes include genetics or environment component
• Host Factors for Bronchial Asthma

  • Genetic predisposition
  • Atopy/allergy
  • Airway hyper responsiveness
  • Gender
  • Race/ethnicity
• Environmental Factors for Bronchial Asthma


  • Allergens
  • Tobacco smoke
  • Air pollution
  • Parasitic infection
  • Obesity
  • Diet
• Asthma Triggers


  • Allergens
  • Irritant gases
  • Smoke
  • House dust mites
  • Cold air
  • Foods
  • Additive
  • Drugs
• Key Prevention of Bronchial Asthma

  1. Recognize what triggers

  2. Avoidance of triggers

  3. Promote breast feeding if possible
• Risk Factor Assessment


  • Cigarette smoking
  • Nutrition/Diet (Vegetables, Fruits, Fats, Sodium/salt)
  • Overweight/Obesity (Weight, Body mass index, Waist circumference, Waist Hip Ratio)
  • Physical inactivity/Sedentary Lifestyle
  • Excessive alcohol drinking
• Screening Guidelines and Procedures

  • Screening for Hypertension (Classification of blood pressure, Apparatus/instrument: mercury manometer, aneroid BP)
  • Screening for elevated cholesterol in the blood (Laboratory test: Total blood cholesterol, Fasting: at least 8 hours)
• Risk Factor Assessment


  1. Cigarette smoking

  2. Nutrition/Diet

  3. Overweight/Obesity

  4. Physical inactivity/Sedentary Lifestyle

  5. Excessive alcohol drinking
• Vegetables


  1. 3 servings/day
• Fruits


  At least 2 servings/day
• Weight-for-age


  Measure of overweight/obesity
• Weight-for-height


  Measure of overweight/obesity
• Body mass index


  Weight in kilogram/height in meters