Non Communicable Diseases

NCDs
Group V Members
1. Elbet Ketema 8. Ezra Legesse
2. Elsabet Wujira 9. Felagot Taddese
3. Emnet Terefe 10. Kal Ayele
4. Enas Imran 11. Kalkidan Getachew
5. Enawgaw Sisay 12. Lemlem Argaw
6. Eskender Nuhedin 13. Mahlet Aberra
7. Ethiopia Tefera
 Outline
 Objectives
 Introduction to Non Communicable diseases /NCDs/
 Characters of NCDs
 Common types of NCDs in Ethiopia
 Trends and burdens of NCDs Globally and in Ethiopia
 The importance of NCDs in low income countries
 Risk factors of NCDs
 Measures to prevent and control NCDs
Objectives
 To define NCDs
 To determine the NCDs global and national impact.
 To analyze national pattern of most common NCDs and their morbidity
and mortality burdens.
 To analyze the importance of NCD in low socio economic/developing
countries.
 To describe risk factors of NCDs
 To forward measures to prevent and control NDCs
Introduction
Non communicable diseases/NCDs/
Definition
 NCDs are diseases or condition which are usually of chronic nature, with slow
onset, lengthy progression for which there are complex causative agents, and
generally are non transmittable from one person to another.

 It has a prolonged course that does not resolve spontaneously, and for which a
complete cure is rarely achieved.
 NCDs Cause 86% of deaths and 77% of the disease burden in the WHO
European Region.

 These disorders are:

 Largely preventable
 Common risk factors
 Similar Underlying determinants and opportunities for
intervention.
Characteristics of NCDs
 Complex etiology/cause/
 Multiple risk factors
 Long latency period
 Non contagious origin/Non communicable/
 Prolonged course of illness
 Functional impairment, disability or even death
Common types of NCDs
 Cardiovascular Disease/CVD/ (e.g., Coronary heart
disease, Stroke)
 Diabetes
 Chronic Respiratory Disease
 Cancer/Neoplasia
 Mental Illnesses
 Chronic Renal Disease
 Unintentional injuries (e.g., from traffic crashes) and others
Common types of NCDs
1. Cardiovascular Diseases
 Cardiovascular disease (CVD) is a group of disorders of the heart and
blood vessels, and may include:

Coronary heart disease Disease of the blood vessels supplying the

heart muscle

Cerebrovascular disease (Stroke) Disease of the blood vessels supplying the brain

Peripheral arterial disease Disease of blood vessels supplying the arms and
legs

Congenital heart disease Malformations of heart structure existing at birth

 con’t
 Prevalence of Rheumatic Heart Disease (RHD) was 6.4 per 1000
population in Addis Ababa, compared to 4.6 per 1000 in a rural town.
 RHD accounts for 34.7% of cardiovascular visits and hospital
admissions from four tertiary hospitals in Addis Ababa and Gondar.
 Hypertension was responsible for 15.2% of CVD visits and admissions
while atherosclerotic heart disease accounted for 8.9%.
 Most common cause of sudden death in Addis Ababa was ascertained to
be Coronary Artery Disease.
 CVDs are the #1 cause of death globally.
 An estimated 17.3 million people died from CVDs in 2008. (30% of all global
deaths)
• 7.3 million were due to coronary heart disease
• 6.2 million were due to stroke
 Over 80% CVD deaths occur in low- and middle- income countries.
 By 2030, almost 25 million people will die from CVDs.
2. Diabetes
 Diabetes is a disorder of metabolism; the way the body uses
digested food for growth and energy.
 a multi system complication disease.
 There are 4 types
 Type 2 is caused by modifiable risk factors and is the most
common worldwide.
>90% of all adult diabetes cases are Type 2
 Diabetes was considered a rare disease in Ethiopia as recently as in the
mid 60’s.
 From the 80’s onward studies of the incidence and prevalence of diabetes.
 Analysis of medical admissions from Addis Ababa and a number of
regional hospitals have shown prevalence ranging from 0.5% to 8.4%.
 The clinical characteristics of Diabetes in Ethiopia, patients demonstrate
that the majority falls under the type 2 category and the minority in type1.
 347 million people worldwide have diabetes.
 In 2004, an estimated 3.4 million people died.
 More than 80% of diabetes deaths occur in low- and middle-
income countries.
 WHO projects that diabetes deaths will increase by two thirds
between 2008 and 2030.
3. Cancer
 Generic term for a large group of diseases that can affect any part of the
body.
 “Rapid creation of abnormal cells that grow beyond their usual
boundaries, and which can then invade adjoining parts of the body and
spread to other organs.”
• Benign tumors
• Malignant tumors
 Con’t
 7.6 million people died from cancer in 2008.
 70% of all Ca deaths occur in low and middle income countries.
 Deaths from cancer are estimated to reach 13.1 million by 2030.
 Most common once in Ethiopia are:
 Cervical Ca
 Lung Ca (Leading cause of cancer death globally,1.37
million deaths in 2008)
 Breast Ca
 Prostatic Ca (2nd most common)
 Colorectal Ca (3rd most common)
 Con’t
 According to the International Agency for Research on Cancer (IARC), the
estimated number of cancer cases in Ethiopia in 2012 was 60,749 (Male-
19,654, Female- 41,095).
 The report indicated that digestive organ cancers (3,956) are the leading
cancers in males, followed by hematopoietic (3,603) and male genital organ
cancers (1,427).
 The leading cancer in females was breast cancer (12,956), followed by female
genital organ cancers (10,181) and cervical cancer (7,095).
4. Chronic Respiratory Diseases
 Bronchial Asthma being the most common non communicable
respiratory illness.
 COPD - term used for lung diseases that prevent proper lung airflow
- 65M people worldwide have moderate to severe COPD.
- More than 3 million people died of COPD in 2005.
 A leading cause of death.
 High under-diagnoses rates.
 90% of deaths occur in low-income countries
 Cigarette smoking was uncommon in Ethiopia until the present
generation which had lately become common in urban areas.
 The rate of smoking in rural areas is about 5.8% which lead to
uncommon diseases like chronic Bronchitis & Lung cancer.
5. Neurologic Diseases
 Cerebrovascular diseases like stroke most commonly
occur in Hypertensive & Diabetic patients who are not
adherent to their medications.
 Epilepsy about 20% of OPD patients showed male
predominance aged b/n 11 & 30 years, GTCS being
common especially with defaulter in therapy.

6. Hepatobiliary diseases

Viral Hepatitis, Liver Cirrhosis & hepatoma are more

prevalent in Ethiopia.
7. Gastrointestinal Diseases
Dyspepsia is one of the most common GI diseases in Ethiopia with
common complication being UGIB.

8. Renal Diseases
Acute Glomerulonephritis, nephrotic syndrome , chronic renal
failure and Nephrolithiasis are common.
Chronic glomerular disease is the most common cause of chronic
renal failure.
9. Bone and Joint diseases
 Rheumatoid arthritis are common

 Autoimmune disorders are less prevalent in Ethiopia.

10. Dermatologic Diseases

Trends and burdens of NCDs Globally and in Ethiopia
 NCDs kill 41 million people each year, equivalent to 71% of all deaths globally.
 Each year, 15 million people die from a NCD between the ages of 30 and 69 years.

 over 85% of these "premature" deaths occur in low- and middle-income countries.

 CVD account for most NCD deaths, or 17.9 million people annually, followed by
cancers (9.0 million), respiratory diseases (3.9million), and diabetes (1.6 million).
 Cont’d

These 4 groups of diseases account for over 80% of all premature NCD deaths.

According to 2016 estimates, non communicable diseases and injuries

represented 46% of the total disease burden in Ethiopia and

 It is expected to rise rapidly in the coming decades along with economic development,
urbanization and life style changes.
 Cont’d

 National cardiovascular disease prevalence is 15%, cancer and chronic obstructive

pulmonary disease prevalence of 4% each, and diabetes mellitus prevalence of 2%.

 Chronic diseases are the leading cause of mortality in the world and contribute
60% of DALYS (disability adjusted life years).

 In Contrary to common perception, 80% of chronic disease deaths occur in lower

and middle income countries where chronic diseases affect younger populations
leading to premature deaths.
 Cont’d

 In 2008, the Ethiopian FMOH conducted a situational analysis and

revealed that diabetes mellitus, cancer, cardiovascular disease, renal diseases
and chronic obstructive pulmonary disease are amongst those with high
burden.

 In Ethiopia, non-communicable diseases (NCDs) cause 42% of deaths, of

which 27% are premature deaths before 70 years of age.
 The Disability Adjusted Life Years (DALYs) increased from below 20% in
1990 to 69% in 2015
Cont’d
Cont’d
Cont’d
  

Cont’d

(Levels and trends of age-standardized death rates per 100,000 by major causes for both sexes
and all age groups in Ethiopia, 1990–2015. (Misganaw et al., 2017)
 Cont’d

Proportional mortality due to NCDs in Ethiopia

19% Cardiovascular diseases

33% Cancer

chronic respiratory diseases

Diabetes mellitus
25%
Other NCDs
15%
4%4% injuries

(World Health Organization - No communicable Diseases (NCD) Country Profiles, 2018.)

Importance of NCDs in low income countries

 Once thought of as diseases of the rich, NCDs are now the leading
causes of death in low- and middle-income countries.
Nearly 30% of NCD-related deaths in low income countries occur under
the age of 60, whereas in high-income countries the proportion is only
13%.

 The prevalence of non-communicable disease risk factors demonstrated

different patterns and varying degrees of socioeconomic inequalities across
low- and middle-income settings
 Cont’d

Non communicable diseases have potentially serious socioeconomic

consequences, through individual and household impoverishment and
hindering social and economic development.

 The rapidly growing burden of NCDs in developing countries is not only

accelerated by population ageing; it is also driven by the negative effects of
globalization.
 Cont’d

 NCDs and their risk factors lead to increased burdens on individuals,

families, communities, and country:
 Impoverishment from long-term treatment and care costs, and
 loss of productivity that threatens household income
 Cont’d

 The distribution and impact of NCDs and their risk factors is highly
inequitable and imposes a disproportionately large burden on low and middle
income countries.

 Poverty is closely linked with NCDs, and the rapid rise in the magnitude of
these health problems is therefore predicted to impede poverty reduction
initiatives in low-income countries and communities.
 Cont’d

 A study conducted in 2011 by the Harvard School of Public Health and the
World Economic Forum over the period 2011-2015 showed that:
 the cumulative lost output in developing countries associated with the four
major NCDs is projected to be more than US$ 7 trillion.

 The annual loss of approximately US$500 billion amounted to approximately 4

per cent of DGP for developing countries in 2010.
 Cont’d

 NCD epidemic has a serious negative impact on human development in

human, social and economic realms.

 It reduce productivity and contribute to poverty and hunger

 create a significant burden on health systems and a growing economic
burden on country economies.
 Impede progress towards the MDGs
Risk factors of NCDs

Risk factor definition:

 An aspect of personal behavior or lifestyle, an environmental exposure, or a
hereditary characteristic that is associated with an increase in the occurrence of
a particular disease, injury, or other health condition.
Types of risk factors
 Modifiable risk factors
 Non modifiable risk factors
 Metabolic risk factors
Modifiable risk factors
 A behavioral risk factor that can be reduced or controlled by intervention,
thereby reducing the probability of disease.
 WHO has prioritized the following four:
‒ Physical inactivity,
‒ Tobacco use,
‒ Alcohol use, and
‒ Unhealthy diets (increased fat and sodium, with low
fruit and vegetable intake)
 Non modifiable risk factors
 A risk factor that cannot be reduced or controlled
by intervention; for example:
• Age,
• Gender,
• Race, and
• Family history (genetics).
Metabolic risk factors
 Metabolic" refers to the biochemical processes involved in the body's
normal functioning
 Behaviors (modifiable risk factors) can lead to metabolic or physiologic
changes
Metabolic risk factors
 WHO has prioritized the following four metabolic risk factors:
‒ Raised blood pressure
‒ Raised total cholesterol
‒ Elevated glucose
‒ Overweight and obesity
Studies in north west Ethiopia on risk factors
Behavioral Risk Factors: Risk Factors Percent Tobacco use 4 Alcohol
consumption 41 Khat consumption 16 Fruit and vegetable consumption 2
Physical inactivity 6  Physical and Biological Risk Factors: Risk Factors
Percent/g Overweight 6% Raised blood pressure 16% Elevated blood glucose
6% Raised total cholesterol 6% Mean salt intake in g 8 g/da
Four shared risk factors for 4 NCDs
Measures to prevent and control NCDs

• Raise priority accorded to NCDs through international cooperation and

advocacy.
• Strengthen national capacity, governance, multisectoral action, and
partnerships.
• Reduce the major modifiable risk factors, such as tobacco use, harmful
use of alcohol, unhealthy diets, and physical inactivity.
Measures to prevent and control NCDs

 Develop and implement effective legal frameworks.

 Orient health systems through people- centered health care and
universal health coverage.
 Promote high-quality research and development.
 Monitor trends, determinants and progress to achieve global,
regional and national targets through evidence-based
interventions.
WHO target plan to reduce NCDs
 References
 Epidemiology and Ecology of Health and diseases in Ethiopia, edited by Yemane
Berhane, Damen Haile Mariam and Helmut kloos, Shema Books, 2006.
 National institute of Diabetes and Digestive and Kidney Diseases, 2012.
 Strengthening chronic disease service in Ethiopia.
 WHO Global burden disease, 2004 WHO, 2011.
 WHO facts on NCDs, 2013.
 WHO Global burden disease, 2004 WHO,2011.
 WHO Global Burden Disease risk factors and contributors, 2018.
 Principles of Epidemiology, CDC, 2006.
 Ethiopia NCDIs commission report, 2018.
Thank you!!!