1. T.D. Medical College,Alappuzha
N.C.D Program for Prevention & Control of Diabetes & Hypertension Status & Strategies
Dr. S.Sajith Kumar MD
Associate Professor in Community Medicine
T.D. Medical College,Alappuzha

2. Trends & Projections of NCDs in India
Diabetes
2000: 32 million (WHO)
2010: 51 million (International Diabetes Federation)
2030: 80 million (WHO)
Cardio-vascular Diseases
1998: 19 million (ICMR)
2005: 38 million (Nat. Com. Macroeconomics & Health)
2015: 64 million (Nat. Com. Macroeconomics & Health)
Cancer
Estimated number of persons with cancer: 2.8 million
Annual Incidence: 1 million

3. Percentage of NCD deaths, by cause in WHO Regions, 2008
Of all deaths due to NCDs, 80% are caused by just four major NCDs—namely cardiovascular diseases which include heart disease and stroke, cancers, chronic respiratory disease and diabetes.
Four major NCDs cause 80% of deaths due to NCDs in all WHO Regions
Source: WHO global Health observatory

4. Distribution of deaths by major cause-India 2001-2003
Based on data from the million death study, NCDs claim the highest number of lives in India. The number of deaths due to NCDs outnumber deaths due to communicable diseases plus maternal and child health problems and nutritional conditions put together.
Deaths due to NCDs outnumber deaths due to communicable diseases, maternal and perinatal causes and nutritional conditions combined
Source: RGI-CGHR Million Death Study

5. Disease Burden due to NCDs
More than 20% of the population have at least one chronic disease
More than 10% have more than one chronic disease

6. Mortality estimates due to NCDs
Globally all deaths (2005) million*
Globally deaths due to NCD (2005) million* (60.3%)
All deaths in India (2004) million #
Deaths due to NCDs in India (2004) 5.2 million #
(50.5%)
* Source: WHO
# Source: ICMR

7. Cancer Scenario: India
Incidence: 10 lakhs /yr
Prevalence: 28 lakhs
Deaths from cancer: lakh / year
Age group affected: % in years
Tobacco related cancers about 40 %
2/3rd cases in advance stage at the time of diagnosis
Common Cancers
Breast, uterine cervix & oral cavity in females
Oral cavity, lung & oesophagus in males  

9. Gaps in the natural history of NCD
Web of causation
Changes in life style stress
Abundance of food lack of physical activity smoking emotional disturbance
aging
Obesity hypertension
Hyperlipidemia thrombotic tendency
changes artery walls
Coronary arthrosclerosis coronary occlusion
Myocardial
infarction

10. Gaps in the natural history of NCD
Long latent period: it is the period between the first exposure to suspected cause and the eventual development of disease. This makes it difficult to link suspected causes with outcomes.
Indefinite onset : Most (NCD) are slow in onset and development. Distinction between diseased and non diseased may be difficult to establish.

11. Prevention of NCD Levels of prevention Primordial Primary Secondary
Tertiary
Primordial prevention- Prevention of the emergence or development of risk factors in countries or population groups in which they have not yet appeared. Efforts are directed towards discouraging children from adopting harmful life styles.
Primary prevention- Action taken prior to the onset of disease which removes the possibility that the disease will ever occur. Can be divided into population & high risk strategy.
For healthy people
For unhealthy people

12. Prevention of NCD Interventions: Health promotion Specific protection
Primary prevention
Interventions:
Health promotion
Specific protection
Adequate nutrition
Safe water and sanitation
Secondary prevention-Action which halts the progress of the disease at its incipient stage and prevents complications. Mostly curative. Disadvantage - patient has already suffered mental & physical anguish & community to loss of production. Often more expensive &less effective. Intervention – EARLY DIAGNOSIS AND TREATMENT
Tertiary prevention- defined as all measures available to reduce impairments & disabilities, minimize suffering due to departure from good health & promote patient’s adjustment to irremediable conditions.Intervention – DISABILITY LIMITATION AND REHABILITATION

14. Objectives
To prevent and control common NCDs through behavior and lifestyle changes
To provide early diagnosis and management of common NCDs
To build capacity at various levels of health care facilities for prevention, diagnosis and treatment of common NCDs
To develop trained human resource within Public Health set up
5. To establish and develop capacity for palliative & rehabilitative care

15. Components Prevention through behaviour change Early Diagnosis
Medical treatment
Capacity building of human resource.
Supervision, monitoring and evaluation

16. Strategies of Programme
Promotion of healthy lifestyle through behaviour change
Opportunistic screening of persons above 30 yrs
Comprehensive examination, diagnosis and management of cancer, diabetes, cardiovascular diseases and stroke
Development of trained manpower
Strengthening of tertiary level health facilities
Programme management at centre, state and district

17. 5000 Sub-Centres 164 Community Health Centres 1000 PHC’s 14 Districts
Implementation
5000 Sub-Centres 164 Community Health Centres 1000 PHC’s 14 Districts

18. Key Interventions for implementation of NPCDCS
Key Area
Activities
Health Promotion
Public awareness through multi-media
Counseling for healthy lifestyle (Balanced diet, regular exercise, avoid alcohol and tobacco)
Early Diagnosis
Screening of persons above 30 years and all pregnant women for diabetes and hypertension at all levels; facilities up to Sub-centre level
Case Management
Facilities for diagnosis and treatment
Capacity Building
Infrastructure Development & Equipment
Training of human resources at all levels
Management & Monitoring
Surveillance, monitoring & evaluation
Regular review meetings

19. Community Awareness
Training of health workers namely ASHA, ANM, and Male Health Workers
Health promotion activities in community, school and workplace settings through IPC, education, mass media etc.
Opportunistic screening using measurement BP for hypertension and blood glucose by strip method for diabetes at community level
Patient referral cards to facilitate referral & follow-up

20. NCD Services at Sub- Centre
Infra structure available
ANM (1) , Male Health worker(1)
Services proposed
‘Opportunistic Screening’ of > 30 years:
NCD risk factors (dietary habits ,physical inactivity, alcohol abuse and tobacco use)
Diabetes by blood sugar strip method
Blood Pressure
Referral to CHC

21. Thank You