Non-Communicable Diseases

definition

• IDs vertical program ⇔ NCDs horizontal program
• some IDs in tropics have NCD-like characterics
  • HIV
  • lymphatic filariasis
  • Chagas disease

epidemiology

• 41 mil. deaths per year worldwide
  • 71% of all deaths
• 15 mil. deaths by NCDs occur between 30 and 69 y/o ... "premature" death

NCDs in LMICs

• tobacco
• food pricing and availability
• food preferences
• physical activity
• technologies
• social movement
• limited research of NCDs in LMICs

measuring burdens of NCDs

• death
• DALY
• QALY
  • 

WHO Package of Essential NCDs intervention (PEN)

• PEN

diabetes and insulin treatment in LMIC

• Insulin Zeer
• cool wallet (ex. Frio)
• DOT (directly observed treatment) like in a refugee camp

• Malnutrition-modulated diabetes mellitus (MMDM)
  • Protein-deficient DM in West Africa
  • Fibrocalculus pancreatic DM
  • onset 10-30 y/o
  • rural origin, poor economic status
  • history of inadequate nutrition since in mother's uterus
  • more severe DM

• tropical diabetic hand syndrome
  • usually after minor trauma
  • seems not due to peripheral angiopathy/neuropathy
  • localised cellulitis confined to hands, often progressive to amputation

stroke

• 2/3 of worldwide stroke occur in developing countries
• 40% occur in <70y/o
• ethnic differences
  • caucasian
  • 80% ischemic stroke
• South Asian
  • 20-30% hemorrhagic stroke
• Africa
  • 26-33% cerebral hemorrhage
• Head CT
  • ≈100% in HICs
  • 90% in LMICs, but confined to a certain size of hospitals to which many residents have difficulty in access
• antiplatelet
  • 92% in HICs
  • 78% in LMICs
• rtPA
  • 30% in HICs
  • 3% in LMICs