This presentation focuses on the most prevailing Non- Communicable diseases of the world. It includes the problem, causes, risk factors, prevention and worldwide statistics of each disease.

1. PREVENTIVEANDSOCIALMEDICINE
Epidemiology of Chronic Non-
Communication Diseases and
Conditions

2. "WHILE THERE
ARE MANY
DISEASES, THERE
IS, IN A SENSE,
ONLY ONE
HEALTH"

3. DEFINITION OF CHRONIC DISEASES
AND CONDITIONS
"An impairment of bodily structure and/or function that necessitates
a modification of the patient's normal life, and has persisted over an
extended period of time".
By EURO symposium in 1957
The Commission on Chronic Illness in USA has defined "chronic
diseases" as "comprising all impairments or deviations from normal,
which have one or more of the following characteristics :
• are permanent
• leave residual disability
• are caused by non-reversible pathological alteration
• require special training of the patient for rehabilitation
• may be expected to require a long period of supervision,
observation or care"

4. THE PROBLEM
?

6. Leading non- communicable
diseases
 Cardiovascular diseases
 Coronary heart disease
 Hypertension
 Stroke
 Rheumatic heart disease
 Cancer
 Diabetes
 Obesity
 Blindness
 Accidents and injury

7. CARDIOVASCULA
R DISEASES

8. • CVD comprise of a group of heart and the
vascular system.
• Major conditions are ischaemic heart
disease (IHD), hypertension,
Cerebrovascular disease (stroke) and
congenital heart disease.
• Rheumatic heart disease continues to be
an important health problem in many
developing countries.

9. THE PROBLEM
WORLD
• Most deaths are attributable to non- communicable diseases
(35 million) and just over half of these (17 million) are as a
result of CVD.
• CVD are responsible for about 25% of the DALYs lost due to
non- communicable diseases in SEAR countries.
• Incidence of CVD is greater in urban areas than in rural areas
reflecting the acquisition of several risk factors such as
tobacco consumption, lack of physical activity, unhealthy diet
and obesity.
• Countries can be benefitted from the strategy of primary
prevention.

10. INDIA
• 29.8 million patients with CVD in India during the year 2003.
• Now, India has 37 million patients with CVDs.
• 1.5 million die of CVD every year.
• India suffers the highest loss in potentially productive years of
life, due to deaths from CVD in people aged 35-64 years.
• The prevalence of CVD is 2-3 times higher in the urban
population as compared to the rural population.
• The present mortality rates are the consequence of previous
exposure to behavioral risk factors such as inappropriate nutrition,
insufficient physical activity and increased tobacco consumption.
• Overweight, central obesity, high blood pressure, dyslipidemia,
diabetes and low cardio-respiratory fitness are among the
biological factors contributing principally to increased risk.

13. • WHO defined stroke as "rapidly developed clinical signs of focal disturbance
of cerebral function; lasting more than 24 hours or leading to death, with no
apparent cause other than vascular origin“.
• The disturbance of cerebral function is caused by three morphological
abnormalities, i.e., stenosis, occlusion or rupture of the arteries.
• Signs and symptoms include include coma, hemiplegia, paraplegia,
monoplegia, multiple paralysis, speech disturbances, nerve paresis, sensory
impairment, etc.
• Of these hemiplegia constitutes the main somatoneurological disorder in
about 90 per cent of patients.
• Stroke includes a number of syndromes with differing aetiologies,
epidemiology, prognosis and treatment. These are listed below :
A. Ischaemic stroke
a. Lacunar infarct
b. Carotid circulation obstruction
c. Vertebra-basilar obstruction
B. Haemorrhagic stroke
a. Spontaneous intracerebral haemorrhage
b. Subarachnoid haemorrhage
c. Intracranial aneurysm
d. Arteriovenous malformations.

14. PROBLEM
• MORBIDITY AND MORTALITY
 In 2008, CVD accounted for 6.1 million deaths worldwide, equivalent
to 10.8 per cent of all deaths.
 In demographically developed countries, the average age at which
stroke occurs is around 73 years reflecting the older age structure of
these countries.
• INDIA
 The proportion of stroke in the young population is significantly more
in India than in developed countries;
 Important causes are rheumatic heart disease, ischemic strokes in
peripartum period and arteriopathies as a sequale of CNS infections
like bacterial and tubercular meningitis etc.
 The prevalence rate of stroke in India is about 1.54 per thousand
and death rate about 0.6 per 1000.
 The total number of stroke cases in India in the year 2004 were
about 9.30 million with about 0.63 million deaths, and total DALYs
lost in 2004 were about 6.36 million.

16. STROKE CONTROL PROGRAM
• The first priority goes to control of arterial hypertension
which is a major cause of stroke.
• Control of diabetes, elimination of smoking, and
prevention and management of other risk factors at the
population level are new approaches.
• Facilities for the long-term follow-up of patients are
essential.
• The education and training of health personnel and of
the public form an integral part of the programme.

19. • Diabetes is a heterogeneous group of diseases, characterized
by a state of chronic hyperglycemia, resulting from a diversity of
aetiologies, environmental and genetic, acting jointly.
• The underlying cause of diabetes is the defective production or
action of insulin.
• Chronic hyperglycaemia leads to a number of complications -
cardiovascular, renal, neurological, ocular and others such as
intercurrent infections.
• CLASSIFICATION

20. PROBLEMWORLD
• Diabetes is an "iceberg" disease.
• Currently the number of cases of diabetes worldwide is estimated to
be around 34 7 million, of these more than 90 per cent are type 2
diabetes.
• Unfavorable modification of lifestyle and dietary habits that are
associated with urbanization are the most important factors for the
development of diabetes.
• Coronary heart disease and stroke are more common in diabetics
than in the general population.
INDIA
• 37. 7 million cases of diabetes in the country, of these 21.4 million
were in urban areas and 16.3 million in rural areas.
• The estimated total mortality due to diabetes was 1.09 lac; 62.5
thousand in urban areas and 46.6 thousand in rural areas.
• Same year 2.2 million DALYs were lost due to the disease.

21. Epidemiological determinants
AGENT
•Pancreatic
disorder
•Defects in
insulin
formation
•Auto- immunity
•Genetic defects
HOST
•Age
•Gender
•Genetic factors
•Obesity
•Maternal
diabetes
ENVIRONMENT
•Sedentary
lifestyle
•Diet
•Malnutrition
•Alcohol
•Dietary fibres

22. RISK FACTORS

23. Prevention of diabetes
PRIMARY
PREVENTION
• Population strategy
• High- risk strategy
SECONDARY
PREVENTION
• To maintain blood
glucose level
• To prevent
complications
• Self care
TERTIARY
PREVENTION
• Diabetes leads to
blindness, kidney failure,
coronary thrombosis,
gangrene of the lower
extremities, etc
• Main objective is to
organize specialized
clinics (Diabetic clinics)
and units capable of
providing diagnostic and
management skills of a
high order.

24. OBESITY

25. • An abnormal growth of the adipose tissue due to an enlargement
of fat cell size or an increase in fat cell number or a combination of
both.
• Obesity is often expressed in terms of BMI.
• PREVELENCE
 Obesity is perhaps the most prevalent form of malnutrition.
 For industrialized countries, such increase in body weight have
been caused primarily by reduced levels of physical activity, rather
than by changes in food intake or by other factors.
 Overweight and obesity are the fifth leading risk of global deaths.
 In 2008, more than 1.4 billion adults, 20 years and older, were
overweight.
 Close to 30 million overweight children are living in developing and
10 million in developed countries.
 In addition, 44 per cent of the diabetes burden, 23 per cent of
ischaemic heart disease burden and between 7 to 41 per cent of
certain cancer burdens are attributable to overweight and obesity.
 In India, 1.3 per cent males and 2.5 per cent females aged more
than 20 years were obese in the year 2008.

26. EPIDEMIOLGICAL DETERMINANTS
Age
Sex
Genetic factors
Physical inactivity
Eating habits
Family tendency
Alcohol & smoking

27. RELATIVE RISK

29. CORONARY
HEART
DISEASE

30. Impairment of heart function due to inadequate blood flow to the heart
compared to its needs, caused by obstructive changes in the coronary
circulation to the heart.
It is the cause of 25-30 per cent of deaths in most industrialized countries.
The WHO has drawn attention to the fact that CHO is our modern "epidemic'',
i.e., a disease that affects populations, not an unavoidable attribute of ageing.
CHO may manifest itself in many presentations :
a. angina pectoris of effort
b. myocardial infarction
c. irregularities of the heart
d. cardiac failure
e. sudden death.

31. Epidemicity
• "Epidemics" of CHD began at different times in different countries.
• The decline in CHD mortality in US and other countries has been attributed to
changes in life-styles and related risk factors (e.g., diet and diet-dependent serum
cholesterol, cigarette use and exercise habits) plus better control of hypertension.
• With 7.2 million deaths and 12.8 per cent of total deaths, CHD is a worldwide
disease.

32. CHD IN INDIA

33. RISK FACTORS OF CHD

34. PREVENTION OF CHD
• Population strategy- CHO is primarily a mass disease.
The strategy should therefore be based on mass
approach focusing mainly on the control of underlying
causes (risk factors) in whole populations, not merely in
individuals. The population strategy centers round the
following key areas: 1. Dietary changes; 2. Smoking; 3.
Blood pressure; 4. Physical activity
(i) prevention in whole populations
(ii) primordial prevention in whole populations
• High risk strategy
• Secondary prevention.

36. VISUAL
IMPAIRMENT
AND
BLINDNESS
loss of useful sight….

37. THE PROBLEM
WORLD
• In 2010 estimation,
285 million people :visually disable
39 million people: blind
246 million people: low vision
• About 80 per cent of blindness is avoidable (treatable or potentially
preventable).
• The major causes of blindness are cataract (33 per cent);
glaucoma (2 per cent); and uncorrected refractive errors (myopia,
hyperopia or astigmatism (43 per cent).
• About 82 per cent of all people who are visually impaired are aged
50 years and older.
• An estimated 19 million children are visually impaired.
INDIA
• The estimated prevalence of blindness in India for the year 2004
was about 11.2 per 1000 population.

39. CHANGING CONCEPT OF EYE HEALTHCARE
• Primary eye care
• Epidemiological approach
• Term concept
• Establishment of national programmes
PREVENTION OF BLINDNESS
• Public education and awareness
• Health fairs
• Eyeglasses cleaning/ adjustment
• Eyeglasses dispensing
•

40. VISION 2020: The Right To Sight
• It is a global initiative to eliminate avoidable blindness
was launched by WHO on 18th Feb 1999.
• The objective of Vision 2020 : To assist member
countries in developing sustainable systems which will
enable them to eliminate avoidable blindness from major
causes i.e. cataract, xerophthalmia and other causes of
childhood blindness, refractive error and low vision,
trachoma and other causes of corneal blindness by the
year 2020.

42. 1. Rheumatic fever is a febrile disease affecting connective tissues
particularly in the heart and joints initiated by infection of the throat by group
A beta hemolytic streptococci.
2. Although RF is not a communicable disease, it results from a
communicable disease (streptococcal pharyngitis).
3. Rheumatic fever often leads to RHO which is a crippling disease.
4. The consequences of RHO include : continuing damage to the heart;
increasing disabilities; repeated hospitalization, and premature death
usually by the age of 35 years or even earlier.
5. RHO is one of the most readily preventable chronic disease.

43. The problem
• WORLD
 Worldwide, there are over 15 million cases of RHO with 282,000 new
cases.
 During 2008, 220,000 deaths from this disease occurred which is about
0.4 per cent of total deaths.
 RHO is a major cause of morbidity and a major cause of mitral
insufficiency and stenosis in the world.
 Insufficiency from acute rheumatic valve disease resolves in 60-80 per
cent of patients who adhere to antibiotic prophylaxis.
• INDIA
 In India, RHD is prevalent in the range of 5-7 per thousand in 5-15 years
age group and there are about 1 million RHD cases in India.
 RHD constitutes 20-30% of hospital admissions due to CVD in India.
 Streptococcal infections are very common especially in children living in
under-privileged conditions, and RF is reported to occur in 1-3 per cent of
those infections.
 Jai Vigyan Mission Mode project on Community Control of RF/RHD in
India is being carried out with four main components, viz. to study the
epidemiology of streptococcal sore throats, establish registries for RF and
RHD, vaccine development for streptococcal infection and conducting
advanced studies on pathological aspects of RF and RHD.

44. EPIDEMIOLOGICAL FACTORS
Agent
Carriers
AGENT
FACTOR 1. Age
2. Gender
3. Immunity
4. Socioeconomic
status
5. High- risk
groups
HOST AND
ENVIRONMENT
AL FACTOR

45. CLINICAL FEATURES
Fever Polyarthritis
Carditis Nodules
Brain
involvement
Skin

46. PREVENTION
• Primary prevention
 The aim is to prevent the first attack of RF, by identifying all patients with
streptococcal throat infection and treating them with penicillin.
 In order to prevent a single case of RHD, several thousand cases of
streptococcal throat infection must be identified and treated.
 If streptococci are present, the child should be put on penicillin.
• Secondary prevention
 It consists in identifying those who have had RF and giving them one
intramuscular injection of benzathine benzyl penicillin (1.2 million units in
adults and 600,000 units in children) at intervals of 3 weeks.
 This must be continued for at least 5 years or until the child reaches 18
years whichever is later.
 For patients with carditis, the treatment should continue for 10 years after
the last attack, or at least until 25 years of age, which ever is longer.
 More severe valvular disease or post-valve surgery cases need life-long
treatment. This prevents streptococcal sore throat and therefore recurrence
of RF and RHD.

48. • Group of diseases characterized by an (i) abnormal growth of
cells (ii) ability to invade adjacent tissues and even distant
organs, and (iii) the eventual death of the affected patient.
• The major categories of cancer are :
(a) Carcinomas, which arise from epithelial cells lining the
internal surfaces of the various organs (e.g. mouth, esophagus,
intestines, uterus) and from the skin epithelium;
(b) Sarcomas, which arise from mesodermal cells constituting
the various connective tissues (e.g. fibrous tissue, fat and bone);
and
(c) Lymphomas, myeloma and leukemia arising from the cells of
bone marrow and immune systems.

49. PROBLEM
WORLD
• In 2012, the worldwide burden of cancer rose to an estimated 14 million
new cases per year, a figure expected to rise to 22 million annually within
the next two decades.
• Cancer deaths are predicted to rise from an estimated 8.2 million annually
to 13 million per year.
• Globally, during 2012, the most common cancers diagnosed were those of
the lung (1.8 million), breast (1.7 million) and colorectal (1.4 million).
• More than 60 per cent of the worlds total cases occur in Africa, Asia, and
Central and South America, and these regions account for about 70 per
cent of the world's cancer deaths.
INDIA
• It is estimated that during the year 2012, 10.15 lac new cancer cases
occurred in the country, of these 4. 77 lac were males and 5.37 lac
females.
• It gives an incidence rate of 92.4 per lac population. Same year about
6.83 lac persons died of cancer.

50. CAUSES OF CANCER
ENVIRONMENTAL FACTORS
• Tobacco
• Alcohol
• Dietary factors
• Occupational exposures
• Viruses
• Customs, habits, lifestyle
GENETIC FACTORS
•Hereditary susceptibility

51. Cancer control
• Control of tobacco and alcohol consumption
• Personal hygiene
• Radiation
• Occupational health
• Immunization
• Cancer education
PRIMARY
PREVENTION
• Cancer registration
• Early detection of cases
• Treatment
SECONDARY
PREVENTION

52. Epidemiology of selected cancers
1. Oral cancer
• During 2012, about 1.98 lac new cases and 98,000 deaths occurred worldwide,
with a mortality rate of 2.1 per lac population.
• During the year, 77,003 new cases occurred in the country with 52,067 deaths
due to oral cancer in India.
• Approximately 90 per cent of oral cancers in South East Asia are linked to
tobacco chewing and tobacco smoking.
• High-risk groups include tobacco chewers and smokers, bidi smokers.
2. Cancer of the cervix
• Second most common cancer among women worldwide, with an estimated 527
,624 new cases and 265,653 deaths with overall incidence: mortality ratio of 52
per cent.
• It comes to 20. 7 per cent of all cancer deaths in women and about 9.9 per cent
of total cancer deaths in the India.
• Causative agent is Human papilloma virus (HPV) – sexually transmitted.
• Early marriage, early coitus, early childbearing and repeated childbirth have
been associated with increasing risk.

53. 3. Breast cancer
• Most common cancer both in developed (794,000 cases) and developing regions (883,000
cases).
• The range of mortality rate is 6-20 per lac, because of the more favorable survival of breast
cancer cases in developed countries.
• About 70,218 women died of this cancer (mortality of 21.5 per cent of all cancer cases),
mortality rate being 12. 7 per lac population, ranking number one killer in women.
• Those whose first pregnancy is delayed to their late thirties are at a higher risk than multiparous
women.
4. Lung cancer
• According to WHO reports, between 1960 and 1980, the death rate due to lung cancer
increased by 76 per cent in men and by 135 per cent in women.
• It was also the most common cause of death from cancer, with 1.58 million deaths (19.4% of
the total).
• More in men than in women.
• About a third of all lung cancer deaths occur below the age of 65.
• Tobacco smoking was first suggested as a cause of lung cancer.
• Methods of controlling the smoking epidemic described by the WHO expert committees:
a. Public information and education
b. Legislative and restrictive measures
c. Smoking cessation activities
d. National and international coordination

55. • Hypertension is a chronic condition of concern due to its role in the
causation of coronary heart disease, stroke and other vascular
complications.
• It is the commonest cardiovascular disorder, posing a major public
health challenge to population in socio-economic and
epidemiological transition.
• It is one of the major risk factors for cardiovascular mortality, which
accounts for 20-50 percent of all deaths.
• CLASSIFICATION-
1. Hypertension is divided into primary (essential) and secondary.
2. Hypertension is classified as "essential" when the causes are
generally unknown. Essential hypertension is the most prevalent
form of hypertension accounting for 90 per cent of all cases of
hypertension.
3. Hypertension is classified as "secondary" when some other
disease process or abnormality is involved in its causation.
Altogether, these are estimated to account for about 10 per cent
or less of the cases of hypertension.

56. RISK FACTORS OF HYPERTENSION
1. Non- modifiable risk factors
• Age
• Gender
• Genetic factors
• Ethnicity
2. Modifiable risk factors
• Obesity
• Salt intake
• Saturated fats
• Dietary fibres
• Alcohol
• Heart rate
• Physical activity
• Environmental stress
• Socio economic factors

57. PREVENTION OF HYPERTENSION
1. PRIMARY PREVENTION- Involves
• Nutrition
• Weight reduction
• Exercise promotion
• Behavioural changes
• Health education
• Self care
2. SECONDARY PREVENTION- Involves
• Early case detection
• Treatment
• Patient compliance

59. ACCIDENT
AND INJURY

60. • An accident has been defined as : "an
unexpected, unplanned occurrence which
may involve injury“.
• Accidents represent a major epidemic of non
communicable disease in the present century.
• Some people are more prone to accidents
than others and susceptibility is increased by
the effect of alcohol and other drugs as well
as physiological state such as fatigue.

61. THE PROBLEM
WORLD

62. INDIA

63. TYPES OF ACCIDENT
• Road traffic accidents
• Domestic accident
a. Snake bite
b. Drowning
c. Burns
d. Falls
e. Poisoning
• Railway accident
• Industrial accident
• Violence

64. PRIMARY FACTORS OF road
ACCIDENT

66. prevention
Data
collection
Safety
education
Promotion of
safety
measures
Alcohol and
other drugs
Primary care
Enforcement
of law
Rehabilitation
services
First- aid

67. CONLUSION

68. • Leading CVD (ischaemic heart disease and
stroke) made the largest contribution to the
total burden of mortality in India in 2017, at
34.3%.
• COPD and asthma makes the second largest
contribution with 10.9%.
• Finally, Diabetes is on third position with 3.1%.
• These three diseases kills 4 million Indians
annually.