ASSIGNMENT ON

“EPIDEMILOGY ”

COURSE CODE: HLT601

SUBMITTED TO : Dr. MRIDULA MISHRA

SUBMITTED BY: Pankaj Devrari

11809316

Max. Marks: 40 Date of Allotment: 30th May Date of Submission: 6th June

MITTAL SCHOOL OF BUSINESS LOVELY PROFESSIONAL UNIVERSITY PUNJAB 144401

1. Identify and discuss the major challenges faced by the various South Asian countries for non-

communicable diseases. Present your answers with facts and figures.

Non-communicable diseases (NCDs)

A non-communicable disease could be a non-infectious health condition that can't be spread from person to
person. It also lasts for an extended period of time. This can be also referred to as a chronic disease.
A combination of genetic, physiological, lifestyle, and environmental factors can also cause these diseases.
Some of the risk factors include:
unhealthy diets
lack of physical activity
smoking and secondhand smoke
excessive use of alcohol

Non-communicable diseases kill around 40 million people annually. this can be about 70 percent of all deaths
worldwide.

Non-communicable diseases affect people belonging to any or all age groups, religions, and countries.

Non-communicable diseases are often related to older people. However, 15 million annual deaths from non-
communicable diseases occur among people aged 30 to 69.

More than 85 percent of those deaths occur in low- and middle-income countries and in vulnerable
communities where access to preventative healthcare is lacking.
SOUTH ASIAN COUNTERIES

Non-communicable diseases (NCDs) like cardiovascular diseases, cancers, diabetes, obesity, chronic
respiratory diseases, musculoskeletal diseases and mental disorders are increasingly contributing to the
disease burden in South Asia, in light of demographic and epidemiologic transitions within the region. Home to
one-quarter of the world's population, the region is additionally a crucial priority area for meeting global
health targets. during this review, we describe the present burden of and trends in four common NCDs
(cardiovascular disease, diabetes, cancer and chronic obstructive pulmonary disease) in South Asia.

Mortality, morbidity, and disability as a result of the key non-communicable diseases account for about 60% of
all deaths and 47% of the world burden of disease; these rates are expected to rise

Almost 1/2 the adult disease burden in South Asia is as a result of non-communicable diseases

Environmental factors are the key determinants of just about all non-communicable diseases

Obstacles to managing the non-communicable diseases epidemic in South Asia include sedentary lifestyles,
extreme poverty, and inadequate health systems.
Non-communicable diseases (NCDs) like cardiovascular diseases, DM, cancer, and chronic respiratory diseases
are on the increase in South East Asia Region (SEAR). NCDs account for nearly 54% of the deaths, significant
amount of disabilities and large socioeconomic losses in countries of SEAR. NCDs are caused by a group of
behavioural risk factors, like tobacco and alcohol consumption, physical activity and unhealthy diet (high in
salt, sugar and fat and low in fruits and vegetables) and biological risk factors like raised vital sign,
raised glucose and impaired cholesterol levels et al..

South Asia is experiencing urbanization, with widening incme and social inequities. The impact of
noncommunicable diseases on the rich and also the poor are likely to vary, in terms of both the principal
causes and manifestations. because the rich are likely to reconnise their risk earlier and seek medical
attention, they're going to develop chronic but manageable disease; because the poor are likely to be
less attentive to their risk and fewer ready to access medical aid, they're going to develop rapidly progressive
disease with early and sudden fatal outcomes To challenge to public health is to anticipate and avert a virulent
disease of non-communicable diseases.

NCDs risk factors are often reduced with existing knowledge through cost- effective policies and programmes,
Establishment of surveillance systems for non-communicable diseases and their risk factors is crucial for
developing prevention strategies and monitoring the impact of control programmes.

• India incorporates a higher number of individuals with diabetes than the other country within
the world
 • Pakistan is among the highest 10 world nations for top numbers of individuals with diabetes

• A third of Pakistanis aged over 45 years have hypertension

• In India 52% of cardiovascular deaths occur below the age of 70, compared with 23% in countries with
established market economies

• In the Maldives, non-communicable diseases account for 48% of all deaths and stroke accounts for 11%
of non-communicable diseases deaths

WHO global strategy for prevention and control of NCDs

WHO objective for NCD Status Key challenges and opportunities

control and prevention

Challenges:
• All SEAR countries have NCD-
To establish and
related departments within • Implementation and
strengthen national
respective ministries of health enforcement of policies and
policies and plans for
programs are often delayed or
the prevention and • 90% of SEAR countries report
different compared with plans
control of NCDs funding for treatment and control
outlined in strategic documents
and prevention of NCDs
such that the intended effects
• National policies and/or programs are lower than expected
for prevention, control or
• Limited human and financial
surveillance of NCDs in India,
resources being made available
Bangladesh, Sri Lanka and
to implement prevention and
Pakistan
control plans

Opportunity:

• Increasing concern about NCDs

among the middle class and
wealthy may improve political
will to address this disease
burden

To promote Challenges:
• India: National Rural Health
WHO objective for NCD Status
control and prevention
interventions to reduce
the main shared
modifiable risk factors
for NCDs: tobacco use,
unhealthy diets,
physical inactivity and
harmful use of alcohol
To monitor NCDs and
their determinants and
evaluate progress at the
national, regional and
global levels
Mission piloting NCD component
in some areas
• Tobacco consumption and
diabetes are particularly targeted
by localized and policy
interventions in the region
• WHO STEPS surveys completed or
initiated in all countries to
monitor NCD risk factors
• Demographic and health surveys
in the region provide
anthropometric and behavioral
data relevant to NCDs; future
studies may incorporate
Key challenges and opportunities
• Poverty is a potent underlying
determinant of unhealthy diet,
tobacco use and harmful alcohol
use and is beyond the direct
purview of public health
• Infrastructure to make physical
activity possible is expensive and
difficult to construct in densely
populated urban centers
• Cultural acceptability of physical
activity and healthy diet
adoption
Opportunities:
• Media consumption, schooling
and physical accessibility of
remote regions are higher in the
region today than ever before,
providing opportunities to reach
a wider population
• Successes in maternal and child
health may be instructive for
behavior change campaigns
targeting NCDs
Challenge:
• Lack of sustainable funding for
infrastructure and human
resources to maintain
surveillance systems
Opportunities:
• Secondary analyses of existing
data to estimate burdens and
WHO objective for NCD Status Key challenges and opportunities
control and prevention

additional objective measures of modifiable risks

chronic diseases and their risk
• Conversion of data to actions
factors (e.g., hypertension, fasting
and interventions to lower NCD
glucose)
burdens
• Cancer registries in India and Sri
• Wider use of registries and data
Lanka
systems to promote quality
monitoring and improve
outcomes

Cardiovascular diseases
CVD burdens are large and growing in South Asia. CHD and stroke are on the increase, while long-established
diseases like rheumatic or hypertensive cardiovascular disease are declining.3 In South Asian countries, the
age of onset of first infarction is, on average, 10 years earlier compared with other countries, and this can
be largely attributed to higher prevalence of CVD risk factors at younger ages.11 Two major case–control
studies on first acute infarction and stroke in countries throughout Africa, Asia, Australia, Europe, the
center East and North and South America—Interheart and Interstroke—found that quite 86% of CVD
was thanks to nine key risk factors [smoking, lipids, hypertension, diabetes, obesity (including abdominal
adiposity), diet, physical activity, alcohol consumption and psychosocial factors].12,13 during this section,
we target CHD and stroke.

Prevalence/incidence
Most of the info on CVD in South Asia came from regional studies within India that use varying data collection
methods; there's a specific lack of knowledge from Pakistan, Nepal and Ceylon.14 In 2003, the prevalence of
CHD in India was estimated to be 3–4% in rural areas and 8–10% in urban areas among adults older than 20
years (∼29.8 million individuals), representing a 2-fold rise in rural areas and a 6-fold rise in urban areas over
four decades.15 The estimated annual incidence of stroke in 2001 was 203 per 100 000 among individuals
ages 20 years and older.16

Morbidity/mortality
Data from 2005 showed that CVD was related to an estimated 11% of morbidity and 29% of mortality in
India.17 Between 1990 and 2010, healthy years of life lost (YLL) from CHD increased dramatically by 73%.2
CHD and stroke are currently leading causes of death in India, and nearly 1/2 these deaths occur among adults
aged 30–60 years old.18
Diabetes
Diabetes could be a complex disorder and growing worldwide.9 Diabetes requires lifelong self-motivated care
and particular attention to controlling glucose, pressure and cholesterol levels. Care can become increasingly
costly over time, requiring progressively more medications to manage risk factors. Longstanding or poorly
controlled diabetes ends up in the emergence of CVD (e.g. CHD, strokes and heart failure),21 eye diseases (e.g.
cataracts, retinopathy),22 chronic uropathy and failure,23 neurovascular limb diseases (e.g. foot ulcers and
peripheral vascular disease, PVD)24 and mental state or cognitive disorders (e.g. depression, dementia).25,26
These conditions are all disabling and sometimes fatal; this was reflected within the GBD report showing that
diabetes could be a leading contributor to years lived with disability.1

Prevalence/incidence
Estimating diabetes prevalence is challenging. Diabetes is asymptomatic until complications set in, so blood
testing is required to understand one's status. wishing on self-report is restricted by recall bias and/or low
awareness of one's status. Another challenge is that there are several biochemical indicators for
diabetes utilized in epidemiologic studies (e.g. fasting and non-fasted glucose levels, glycated hemoglobin and
oral glucose tolerance tests), which don't seem to be perfectly congruent, so estimates from studies using
different indicators and different thresholds don't seem to be comparable. Furthermore, epidemiologic
studies are rarely able to obtain glucose measurements at double, the clinical gold standard for diagnostic
purposes.

Despite data limitations, South Asia is taken into account an epicenter of the worldwide diabetes
epidemic. consistent with the International Diabetes Federation's 2013 estimates, almost 80 million people or
21% of all diabetes cases worldwide sleep in South Asia. India, the region's most populous country, is home
to quite 65 million people stricken by diabetes, the second highest worldwide (after China).9 Nationally,
representative country-specific data are limited within the region and prevalence estimates were
previously supported small studies that used non-comparable sampling and data collection approaches.
Uniformly collected data in 2011 from four states of India estimated that 6.2% of adults in India are stricken
by diabetes.27 Meanwhile, 2007 data from Pakistan (9.3% in males and 11.1% in females)28
and Ceylon (10.9%)29 also show high prevalence. Diabetes prevalence is notably two to 3 times higher in
urban (e.g. 12–20%) compared with rural populations (5–6%) of South Asia.27,30

Morbidity/mortality
Most available data regarding diabetes complications in South Asia are from clinical settings. this can
be largely because measuring diabetes complications accurately at a population level requires complex and
dear tests (e.g. retinal photographs), which are difficult to integrate into routine chronic disease surveillance.
Baseline data from an oversized trial across 885 clinical centers showed that 22.7 and 41.8% of diabetes
patients had some variety of macro- (CHD, PVD) or microvascular complication (neuropathy, retinopathy),
respectively.35 Data from clinics in Karachi in 2004 showed that 26.4, 6.8 and 3.9% of diabetes patients had
stable CHD, previous strokes and diabetic foot, respectively.36 Similar estimates for CHD (27.2%), strokes
(9.2%) and PVD or gangrene (4.2%) have also been noted at hospital follow-up in Bombay, although data come
from 15 years earlier.37 Data from randomly sampled primary, secondary and tertiary care facilities
in Ceylon in 2006 report high prevalence of neuropathy (25.2%), CHD (12.4%), retinopathy (20.0%) and
nephropathy (22.8%).38 Finally, population-based data from Chennai in 2009 show high prevalence of
retinopathy (17.5%), neuropathy (25.7%), nephropathy (5.1%) and microalbuminuria (26.5%).39

India encompasses a higher number of individuals with diabetes than the other country within the world

Evaluation of health systems interventions for vascular risk reduction in primary healthcare settings in
developing countries (conducted by the Initiative for Cardiovascular Health Research within the Developing
Countries (IC-Health), New Delhi)

Lady medical expert heart health project (conducted by Heartfile, a number one national non-governmental
organisation in Pakistan)

Reorientation of health services to manage non-communicable diseases (conducted by Heartfile, Pakistan)

Risk factor surveillance programmes under WHO's STEPS programme (a graded approach to surveillance of
non-communicable diseases, developed and implemented by WHO)

Global programme for assessing coronary risk factors (conducted in 41 countries by INTERHEART, a case-
control study of risk factors for myocardial infarction)

Conclusion

The health burdens of non-communicable diseases are high in South Asia, though there are differences among
countries and within urban and rural areas of every country, counting on the extent of developmental and
epidemiological transition. Many of those disease burdens occur within the productive mid-life period and
can, therefore, adversely affect workforce productivity and economic development. Although the absence of
well established disease surveillance mechanisms prevents precise estimation of the dimensions of
noncommunicable disease burdens, the direction of change is clear—the burden is rising. More accurate
estimation of those burdens, their risk factors, and time trends would help to raised inform policy and to
watch change in response to public health interventions. Even at the present state of data, however, the
magnitude of the matter is large enough to demand urgent attention and action.
2. Prepare the analytical report on the basis news presented in news media about Accidents and

injuries in the hospitals and suggest the preventative measures to the government.

Though hospitals are generally thought of as medical establishments that are safe, and promote health and
healing, they're not immune from being the reason behind accidents and injury. Since patients are usually in
an exceedingly vulnerable state while admitted, courts will generally consider accidents as foreseeable events
in personal injury lawsuits. the subsequent are some hospital accident statistics that are compiled in recent
years:
• In 2018, Hopkins released a study that estimates 250,000 people die annually from medical errors; whereas
the Journal of Patient Safety estimates the price at 440,000.
• Medical Errors are the third leading reason behind death within the US.
• Louisiana has the foremost medical malpractice lawsuits filed per 100,000 residents within the U.S., at 44.1.
• One in three patients admitted to a hospital suffer some quite medical error.
• In 2016, an Illinois jury awarded $53 million in damages for future expenses of a boy who suffered brain
injury leading to brain disorder at birth.
• “Never events” like wrong site, wrong patient, and wrong surgery events are occurring at a rate of 40 times
per week in hospitals nationwide.
• In 2016, the most important settlement for medical malpractice in California history was awarded to a
mother and her 3 year old child. the kid suffered brain damage and brain disorder from a feeding-tube error,
after being born prematurely. They were awarded $20 million in damages.
• The rate of payouts on medical malpractice claims dropped 56% between 1992 and 2014, but the
typical payout per claim rose 23% rounding out around $353,000 from roughly $287,000 per claim within
the mid-1990’s.
• Medical complications from hospital accidents cost Medicare roughly $4.4 billion annually.

2012 2014 2016 2018 2014

Num Num Num

Rate Rate Numbe Rate per Number Rate
ber ber ber Rate per
per per r 1000 injuries per
injur injur injuri 1000
1000 1000 injuries 1000
ies ies es

5159 22.4 6902 29.2 7125 29 7636 31 4,450 18

Healthcare
 9000

8000

7000

6000

5000
no. of injuries
4000 rate per 1000

3000

2000

1000

0
2012 2014 2016 2018

MOST COMMON HEALTHCARE ACCIDENTS

The Bureau of Labor Statistics collects data on the foremost common healthcare accidents that lead
to days aloof from work. They are:

OVEREXERTION AND BODILY REACTION

In 2014, the Bureau of Labor Statistics reported that the speed of overexertion injuries for hospital workers
was twice the typical of full-time workers across all industries. the best risk factor for overexertion injuries in
healthcare jobs is that the manual lifting, moving, and repositioning of patients.

SLIPS, TRIPS, AND FALLS

There are many hazards in hospitals that may lead a healthcare worker to slide or trip and fall. Spilled water or
liquids can create a slippery walking surface, as can damaged flooring in patient rooms and hallways. Loose
cords, hoses, wires, and medical tubing also can contribute to a fall.

CONTACT WITH OBJECTS

Hospitals are full of sharp objects that may cause a puncture wound or laceration to a healthcare worker.
Contact with surgical instruments, broken glass, needles, and other sharp objects are a number of the
foremost common healthcare injuries.

VIOLENCE
Healthcare workers are at a high risk for being assaulted on the work. Doctors, nurses, and other medical
professionals may receive verbal threats or be physically attacked by patients, distraught relations, intruders,
and even co-workers.
EXPOSURE TO SUBSTANCES
Not only is figure within the healthcare industry physically grueling, but healthcare workers are exposed to
airborne pathogens that may cause infections, further as needlesticks than can transmit bloodborne infectious
diseases like HIV/AIDS.

Many hospitals during this country have safety records that wouldn’t be tolerated in the other industry. The
statistics are alarming:

As many as 440,000 people die per annum from hospital errors, injuries, accidents, and infections
Every year, 1 out of each 25 patients develops an infection while within the hospital—an infection that
didn’t should happen.
A Medicare patient features a 1 in 4 chance of experiencing injury, harm or death when admitted to a hospital
Today alone, over 1000 people will die due to a preventable hospital error
It’s important to recollect that almost all hospital errors will be prevented. Hospitals have to push daily to
guard their patients from errors, injuries, accidents, and infections.

Proportion of reported non-fatal injuries

 Most injured body parts

Reported non-fatal injuries by work environment

 Number of fatalities (worker and non-worker) by accident trigger

Preventable measures for hospital accidents and injuries

Incorporate a security and wellness plan. the inspiration for a secure work environment is a good accident
prevention and wellness program. The program has to cover all levels of employee safety and health with the
encouragement to report hazardous practices or behavior.

Conduct pre-placement physicals. Some accidents are caused by inexperience and also the inability to
physically perform the position. Screening applicants could be a safeguard for placement with the
acceptable positions matching their physical capabilities.

Educate employees and management staff. Continually cultivate a security standard among employees and
management staff. Train employees about the importance of following safety measures as often as possible.
Supplemental training in body mechanics can reduce strain injuries, and keep employees safe during lifting
and moving.

Research safety vulnerabilities. Every business is exclusive and doesn’t necessarily have the identical safety
concerns. Pay extra attention to common accidents and develop strategies to stay these setbacks from
happening.

Provide protection equipment. Personal protection equipment is crucial and will be enforced at hiring,
meetings, and with spontaneous monitoring. Take time to show employees the way to properly use goggles,
face protection, gloves, hard hats, safety shoes, and earplugs or ear muffs.

Have adequate staffing levels. More often than not, overtime hours are implemented due to low staffing
levels. Overworked employees may suffer from exhaustion and perform to fulfill or exceed output. Hiring part-
time or seasonal staff could help prevent accidents because of exhaustion.

Don’t take shortcuts. Accidents happen when employees skip steps to finish employment sooner
than schedule. ensure all instructions are clear and arranged to stop undue mishaps within the workplace.

Inspect and maintain all company vehicles. in line with The Occupational Safety and Health Act findings,
workplace-driving accidents cost employers a mean of $60 billion dollars a year. Maintenance should include
monthly inspections and repairing vehicles as soon as possible.

Monitor safety measures. After initial training, reinforce safety measures at every opportunity, i.e. staff
meetings, supervision, and education. Reward employees who abide by setting standards or staying injury free
for a specified amount of your time.

Keep an orderly workplace. Poor housekeeping can cause serious health and safety hazards. The layout of the
workplace should have adequate foot path markings, be freed from debris, and stations for cleaning up spills.
3. Prepare the report on Mortality Rates during corona pandemic in the four zone (North, South,

East and West) of India.

Mortality rate, or death rate, may be a measure of the quantity of deaths (in general, or thanks to a
particular cause) in an exceedingly particular population, scaled to the dimensions of that population, per
unit of your time. mortality is often expressed in units of deaths per 1,000 individuals per year; thus,
a mortality of 9.5 (out of 1,000) in an exceedingly population of 1,000 would mean 9.5 deaths per annum in
this entire population, or 0.95% out of the full.

North Zone: North zone of India houses the sates of Himachal Pradesh, Punjab, Uttarakhand , Uttar
Pradesh and Haryana.
 300

250

200

Death
150
Column1
100 Column2

50

0
Himachal Punjab Uttarakhand uttar Pradesh Haryana
Pradesh

East Zone: the east zone is comprised of states of Bihar, Orissa, Jharkhand, and West Bengal.

400

350

300

250
Death
200
Column1
Column2
150

100

50

0
Bihar Orissa Jharkhand Weat bengal

West Zone: This zone has the states of Rajasthan , Gujarat, Goa and Maharashtra.
 3000

2500

2000

Death
1500
Column1
Column2
1000

500

0
Rajastan Gujrat Maharastra

South Zone: States of Andhra Pradesh, Karnataka, Kerala and Tamil Nadu

250

200

150
Death
Column1
100 Column2

50

0
Andhra Pradesh Karnataka Kerala Tamil nadu

Mortality rate of india is 3.21% due to covid 19 in 2020

4. Compare the Inpatient and Outpatient Statistical report from 2018 to 2020 on any chosen

parameters.

Inpatient service is any service you have got once you’ve been formally admitted to a hospital. As either on a
daily basis or overnight patient. So outpatient is anything where you’re not formally admitted to hospital.”

Hospital outpatient revenue is catching up to inpatient revenue, consistent with data released from the
American Hospital Association (AHA). This increase is an element of a growing trend to cut back healthcare
costs by treating patients outside of hospital settings. It’s a trend that's supported by the White House and
Medicare and continues to impact clinical laboratories, which serve both hospital inpatient and outpatient
customers.

The AHA published this study data in its annual Hospital Statistics, 2019 Edition. the info comes from a 2017
survey of 5,262 US hospitals. The report includes data about utilization, revenue, expenses, and other
indicators for 2017, additionally as historical data.

The AHA statistics on outpatient revenue suggest providers nationwide are working to stay people out
of dearer hospital settings. Hospitals, like medical laboratories, appear to be succeeding at developing
outpatient and outreach services that generate needed operating revenue.

This aligns with Medicare’s push to create healthcare more accessible through outpatient settings, like urgent
care clinics and physician’s offices. A growing trend Dark Daily has covered extensively.

Outpatient Revenue Climbs

In its coverage of the AHA’s study, Modern Healthcare reported that 2017 hospital net inpatient revenue was
$498 billion and net outpatient revenue was $472 billion.

The Becker’s Hospital CFO Report notes that gross inpatient revenue in 2017 was $92.7 billion more than gross
outpatient revenue. But in 2016, gross inpatient revenue was much further ahead—$129.5 billion over gross
outpatient revenue. The “divide” between inpatient and outpatient revenue is narrowing, Becker’s reports.

The Becker’s report also stated:

Admissions increased by but 1% to 34.3 million in 2017, up from 34 million in 2016;

Inpatient days were flat at 186.2 million;
Outpatient visits rose by 1.2% to 766 million in 2017; and,
Outpatient revenue increased 5.7% between 2016 and 2017.
Similar Study Offers Additional Insight into 2018 Outpatient Revenue

A benchmarking report by Crowe, a public accounting, consulting, and technology firm, which analyzed data
from 622 hospitals for the amount January through September of 2017 and 2018, showed the subsequent, as
reported by RevCycleIntelligence:

Inpatient volume was up 0.6% in 2018 and sales per case grew by 5.3%;
Outpatient services rose 2.4% in 2018 and sales per case was up 7.1%.
Physicians’ Offices Have Lower Prices for a few Hospital Outpatient Services

Everything, however, is relative. When certain healthcare services traditionally rendered in physician’s offices
are rendered, instead, in hospital outpatient settings, the numbers tell a unique story.

In fact, in keeping with the Health Care Cost Institute (HCCI), the value for services was “always higher” when
performed in an outpatient setting, as compared to doctor’s offices.

HCCI analyzed services at outpatient facilities moreover as those appropriate to freestanding physician offices.
They found the subsequent differences in 2017 prices:

Diagnostic and screening ultrasound: $241 in physician’s office—$650 in hospital outpatient setting;
Level 5 drug administration: $254 in office—$664 in hospital outpatient setting;
Upper airway endoscopy: $527 in office—$2,679 in hospital outpatient setting.