1. NCDS

2. • NCD a very large catch-all term
– Chronic diseases
– Reproductive health
– Mental health
– injuries
• Often used for chronic conditions

3. NCDs
• Biggest cause of death worldwide.
– More than 36 million people died from NCDs in 2008
– More than 9 million of these deaths occurred prematurely
(before the age of 60) and could have largely been
prevented.
• Premature deaths from NCDs by sex
and country category
– 22% among men and 35% among women in low-income
countries
– 8% among men and 10% among women in high-income
countries.

4. NCDS
• Main NCD causes of death
– cardiovascular diseases (48%)
– cancers (21%)
– Chronic respiratory diseases (12%)
– diabetes (3%)
• Other NCDs
– blood disorders
– renal disease
– Arthritis
– epilepsy

5. NCD Risk factors
• 4 main behavioral risk factors
that contribute to NCDs
– tobacco use,
– physical inactivity,
– harmful use of alcohol
– unhealthy diet

6. Other key factors
• Level of investment in health/health systems
• Globalization - promotes diets rich in calories, salt and fat
• Poverty - affects affordability of healthy food and health
care, affects access to health information and means of
prevention
• Rapid urbanization - contributes to physical inactivity;
• Obesity- as a result of diet and reduction in physical activity;
• High levels of indoor and outdoor air pollution;
• Increasing prevalence of alcohol abuse;
• Poor governance, corruption and lack of accountability of
governments and systems, including health systems;
• Ageing of populations.

7. % deaths from NCDs
• Low- and lower-middle-income
countries have the highest
proportion of deaths under 60
from NCDs.
– for high-income countries - 13%
– for upper-middle-income countries- 25%
– for lower-middle-income countries -28%
– for low-income countries - 41%

17. NCD Care
• Package of Essential
Noncommunicable
(PEN) Disease
Interventions for
Primary Health Care in
Low-Resource Settings
– Prevention
– Treatment
– Rehabilitation
– palliative care

18. Sexual and Reproductive Health
• Defined in the Programme of Action of the International
Conference on Population and Development (ICPD) held in
Cairo, Egypt, in September 1994 includes:
– family-planning
– Safe delivery
– prevention and appropriate treatment of infertility;
– prevention of abortion and the management of the
consequences of abortion;
– treatment of reproductive tract infections, STI including HIV
– prevention, early detection and treatment of breast cancer and
cancers of the reproductive system, and other RH conditions;
– active discouragement of harmful traditional practices, such as
female genital mutilation.

19. SRH & MDGs
• GOAL 5: IMPROVE MATERNAL HEALTH
• Target 5.A:
Reduce by three quarters the maternal mortality ratio
– 5.1 Maternal mortality ratio
– 5.2 Proportion of births attended by skilled health personnel
• Target 5.B:
Achieve universal access to reproductive health
– 5.3 Contraceptive prevalence rate
– 5.4 Adolescent birth rate
– 5.5 Antenatal care coverage (at least one visit and at least four
visits)
– 5.6 Unmet need for family planning

20. SRH in crises
• Previously ignored
• BUT now recognized as critical in crises (
MISP), CERF life-saving criteria
• Investments needed for SRH also critical for
other health issues
– Blood transfusion
– Surgical capacity
– Referral system …

21. Key Indicators for SRH
• # HF with basic essential obstetric care/500 000
population, by admin unit
o >= 4 BOEC/500 000
• # HF with comprehensive essential obstetric
• care/500 000 population, by admin unit
o >= 1 CEOC/500 000
• % births assisted by skilled attendant
o > 90%
• % expected deliveries by Caesarean section, by admin
unit
o >= 5% and <= 15%

22. Abortions
• 10-15% of all pregnancies may spontaneously abort
before 20 weeks gestation
• 90% of these will occur during the first three months
• 15-20% of all spontaneous abortions that occur require
medical interventions
Hypertension
• 5-20% of all pregnancies will develop hypertensive
disorder of pregnancy (HDP)
• 5-25% of all primigravida pregnancies will develop HDP
or Pre-eclampsia

23. Labor and delivery complications
– 15% of all pregnancies will require some type of intervention at
delivery
– 5-15% of all pregnancies will require a Caesarean section
– 10-15% of all women will have some degree of cephalopelvic
disproportion (higher in poorer socioeconomic populations)
– 10% of deliveries will involve a primary postpartum hemorrhage
(within 24 hours of delivery)
– 0.1-1.0% of deliveries will involve a secondary postpartum
hemorrhage (occurring 24 hours or more after delivery)
– 0.1-0.4% deliveries will result in uterine rupture
– 0.25-2.4% of all deliveries will result in some type of birth trauma to
the baby
– 1.5% of all births will have a congenital malformation(does not
include cardiac malformations diagnosed later in neonatal period).
– 31% of these malformations will result in death.

24. MISP
• Focuses on minimum set of services that must
be available even in crisis
• Basis for expanded set of SRH services
• Often services do not exist before

25. Maternal mortality
• Key causes
– Postpartum hemorrhage (bleeding after delivery)
– Sepsis (infection after delivery)
– Unsafe abortion
– Hypertension or eclampsia (high blood pressure or
severe high blood pressure)
– Obstructed labor
– Other direct obstetric causes
– Indirect causes such as malaria, anaemia, heart
disease, or other pre-existing conditions

26. Preventing maternal deaths
• 3 delays
– Delay in recognizing a complication
– Delay in deciding to seek health care/in reaching a
health care facility
– Delay in receiving appropriate treatment/quality
care

27. Key SRH in Crises initiatives
• Inter-agency Working Group on Reproductive
Health in Crises (IAWG)
• Reproductive Health Response in Conflict
(RHRC) Consortium
• Reproductive Health Access, Information and
Services in Emergencies (RAISE) Initiative
• Sexual and Reproductive Health Programme In
Crisis and Post-Crisis Situations (SPRINT
Initiative)

28. Exercise: Estimating number of pregnant
women in population (per 100,000)
• Need to know: CBR, affected population size

29. Mental health
• mental disorders
• Neurological disorders
– Epilepsy/seizures
• Drug/alcohol
• Psychosocial support

30. MHPSS in emergencies
• Previously under-addressed
• Important for:
– Dignity
– Rights
– Reduction of risk for death
• IASC Task Force - reference group
– Guidelines +
– Specific emergency support
• Addition of 5 psychotropic drugs in IEHK revision

31. For next week….
• You are a research assistant to a prominent
journalist who frequently highlights issues of
sexual violence in his writings about
humanitarian settings (but not always
accurately and not always covering other
issues of violence in the settings). Prepare a
brief about the data available about violence
including sexual violence in the crisis you are
following.