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
    • DALY and QALY.jpg

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
  • 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