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T.D. Medical College,Alappuzha

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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

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