1、Non-Communicable Diseases Control Program _K R Thankappan MD, MPH Additional Professor and Head Achutha Menon Centre for Health Science Studies Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum,Injuries (9.1%),Noncommunicable conditions (59.8%),Death, by broad cause group
2、, 1999,Communicable diseases, maternal and perinatal conditions and nutritional deficiencies (31.1%),Source: WHO Report 2000,Injuries (13.9%),Noncommunicable conditions (43.2%),Global burden of disease in disability-adjusted life years (DALYs), 1999,Communicable diseases, maternal and perinatal cond
3、itions and nutritional deficiencies (42.8%),Source: WHO Report 2000,Deaths, by broad cause group and WHO Region, 1999,AFR,EMR,EUR,SEAR,WPR,AMR,25,50,75,%,Communicable diseases, maternal and perinatal conditions and nutritional deficiencies,Noncommunicable conditions,Injuries,Source: WHO 2000,DALYS,
4、by broad cause group and WHO Region, 1999,AFR,EMR,EUR,SEAR,WPR,AMR,DALY = Disability adjusted life-year,Communicable diseases, maternal and perinatal conditions and nutritional deficiencies,Noncommunicable conditions,Injuries,25,50,75,%,Source: WHO 2000,Source: WHO, Evidence, Information and Policy,
5、 2000,DALY = Disability-Adjusted Life Year,Communicable diseases, maternal and perinatal conditions and nutritional deficiencies,Noncommunicable conditions,Neuropsychiatric disorders,Injuries,43,14,22,21,49,27,15,9,%,%,DALYs, by broad cause group 1990 - 2020 in developing countries (baseline scenari
6、o),Low- and middle-income countries suffer the greatest impact on non-communicable diseases,77% of the total number of deaths attributable to NCDs occurred in developing countries,85% of the global NCD disease burden borne by low- and middle-income countries,Source: WHO:, 2000,Malaria (69),HIV/AIDS
7、(360),Tuberculosis (723),Diarrhoeal diseases (978),Injuries (1301),Noncommunicable conditions (7370),Maternal conditions (158),Childhood diseases (542),Respiratory infections (1523),Distribution of causes of death in South-East Asia, 1999 (000s),Other causes (236),Nutritional deficiencies (159),Peri
8、natal conditions (851),Source: WHO 2000,Malaria (3071),HIV/AIDS (8866),Tuberculosis (14101),Diarrhoeal diseases (30017),Injuries (65289),Noncommunicable conditions (156536),Maternal conditions (7733),Childhood diseases (19449),Respiratory infections (38144),Other causes (19693),Burden of disease in
9、disability-adjusted life years (DALYs) in South-East Asia,1999 (000s),Nutritional deficiencies (16866),Perinatal conditions (32715),Source: WHO 2000,Cardiovascular (CVD) epidemic in countries of different stages of development,-1940-1950-1960-1970-1980-1990-2000-,High Income Economies,Economies in T
10、ransition,Middle and Low Income Countries,25,50,%,Communicable diseases, maternal and perinatal conditions and nutritional deficiencies,Injuries,DALYs, by broad cause group 1990 - 2020 in developing countries (baseline scenario),DALY = Disability adjusted life-year,1990,2020,Source: WHO, Evidence, I
11、nformation and Policy, 2000,Noncommunicable conditions,Source: K S Reddy. Lancet 1998.,Coronary Heart Disease Prevalence Studies in India (Urban) Study Year Sample CHD Prevalence Agra 1960 1046 11 1.05 Delhi 1962 1642 17 1.04 Chandigarh 1968 2030 134 6.60 Rohtak 1975 1407 51 3.63 Delhi 1990 13723 13
12、27 9.67 Jaipur 1995 2212 168 7.59 Moradabad 1995 152 13 8.55 Trivandrum 1995 506 41 12.65 _ Source: Gupta et al. Indian Heart Journal 1995.,Prevalence Of Hypertension in the elderly Loacation % 95% CI Kerala Urban 69 (63-75) Kerala Rural 55 (49-61) Maharashtra Urban 72 (69-75) Dhaka Urban 65 (62-67)
13、 Dhaka Rural 53 (47-59) _ Source. Hypertension study group AMCHSS of SCTIMST. WHO Bulletin 2001.,Prevalence of Hypertension (40-60 Yrs) Trivandrum City Age group Prevalence 40-44 42.2 45-49 55.3 50-54 55.7 55-60 67.2 Total 54.5 Manu Zachariah, Thankappan K R et al. Indian Heart Journal 2003,Cardiova
14、scular risk factors,8.4 million,3 million,Established Market Economies,Middle Eastern Crescent,Latin America & Caribbean,Sub-Saharan Africa,Other Asia and Islands,China,India,Former Socialist Countries,Tobacco: deaths by World Bank regions estimates for 1990 and 2020,Source: Murray CJL, Lopez AD 199
15、6,Tobacco use and educational level among females in Bombay 1992-1994,Source: Gupta, 1996,Users %,Body Mass Index in Indian Women 15-49 Years. State BMI 18.5 BMI 25+ BMI 30+ Delhi 12.0 33.8 9.2 Punjab 16.9 30.2 9.1 Kerala 18.7 20.6 3.8 Orissa 48.0 04.4 0.6 Assam 27.1 04.2 0.7 Bihar 39.3 03.7 0.5 Ind
16、ia 35.8 10.6 2.2 Urban 22.6 23.5 5.8 Rural 40.6 05.9 0.9 Source: NFHS 1998-99.,No National Program for NCD More than 50% of disease burden in India is due to NCDs Many National Programs for Communicable diseases,How to address Monitoring of Risk factorsTobacco Use Diet (Fruits and Vegetables) Body M
17、ass Index Physical activity Blood Sugar Blood Lipid levels,Disease Specific Program Cancer Diabetes Bronchial Asthma Hypertension?,Need to develop a Program Sentinel Health Monitoring Centres Assam Delhi Kerala Maharashtra Tamil Nadu,Address Risk factors and determinants at community level Inter-sec
18、toral coordination,Legislation For example Tobacco Control Alcohol Diet, salt restriction Exercise,Global strategy for Diet and Physical activity,Primary Health Care System Need to re-orient focus Training of health workers Monitoring of blood pressure and urine sugar can be done at grass root level Health education programs,Capacity Building Manpower -PH specialists New Public Health Schools Social Science components MPH-SCTIMST, Allahabad PGI Chandigarh, CMC Vellore, EHA Expand the current MD programs FETP Programs- MAE at NIE,Start From Children,THANK YOU,
