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

NCDs among children and adolescent

• WHO definition for NCD deaths exclude that in < 30 y/o
• insufficient data
• rheumatic heart disease
  • 15.6 mil. per year
• Sickle cell anemia
  • 70% of world cases in Sub-Sahara
• pediatric and adolescent malignancy
  • cure rate 80% in HICs, 20% in LMICs
• bronchial asthma
  • high risk factor is solid fuel burned inside house
• suicide
  • third leading deaths in 15-19 y/o
  • risk
    • sexual violence
    • bullying
    • discrimination
    • in conflict or disaster zone
• injuries and violence
  • intentional
    • self
    • by others
  • unintentional 90%
    • 1st deaths in 10-19 y/o
    • road traffic accidents 93% in LMIs
    • drowning
    • burns, death rate in LMIC 11 times higher than in HIC
    • fall
    • poisoning

cancer and palliative care

• cancer 2nd deaths worldwide
• 9.6 mil. deaths in 2018
  • 1 in 6 deaths
• incidence in both sexes
  • 1 lung, 2 breast, 3 colon, 4 prostate
• mortality in both sexes
  • 1 lung, 2 colon, 3 stomach, 4 liver

• only 26% of LMICs have pathology service available
• only 20% of LMICs have cancer data

• 1/3 of death by cancer are potentially preventable
  • obesity reduction
  • smoking cessation
  • alcohol reduction
  • infection control for HPV, HepB, HepC, H. pyroli
  • occupational exposures to environmental carcinogenic agents

HPV

• 90% of HPV infection spontaneously regress within 24 months
• risk factors of infection
  • early sexual activity
  • young age at first birth
  • multiple pregnancies
  • multiple
• risk factors of cervical cancers
  • HPV type
  • immune status
  • coinfections with other STIs including HIV
  • multiparity and young age at first birth
  • tobacco
  • OC > 5 years, but it is confounding with sexual activity