Non-Communicable Diseases

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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)

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