Action to address the household economic burden of non-communicable diseases.

PubMed

Jan, Stephen; Laba, Tracey-Lea; Essue, Beverley M; Gheorghe, Adrian; Muhunthan, Janani; Engelgau, Michael; Mahal, Ajay; Griffiths, Ulla; McIntyre, Diane; Meng, Qingyue; Nugent, Rachel; Atun, Rifat

2018-05-19

The economic burden on households of non-communicable diseases (NCDs), including cardiovascular diseases, cancer, respiratory diseases, and diabetes, poses major challenges to global poverty alleviation efforts. For patients with NCDs, being uninsured is associated with 2-7-fold higher odds of catastrophic levels of out-of-pocket costs; however, the protection offered by health insurance is often incomplete. To enable coverage of the predictable and long-term costs of treatment, national programmes to extend financial protection should be based on schemes that entail compulsory enrolment or be financed through taxation. Priority should be given to eliminating financial barriers to the uptake of and adherence to interventions that are cost-effective and are designed to help the poor. In concert with programmes to strengthen national health systems and governance arrangements, comprehensive financial protection against the growing burden of NCDs is crucial in meeting the UN's Sustainable Development Goals. Copyright © 2018 Elsevier Ltd. All rights reserved.

The Built Environment—A Missing “Cause of the Causes” of Non-Communicable Diseases

PubMed Central

Walls, Kelvin L.; Boulic, Mikael; Boddy, John W. D.

2016-01-01

The United Nations “25 × 25 Strategy” of decreasing non-communicable diseases (NCDs), including cardiovascular diseases, diabetes, cancer and chronic respiratory diseases, by 25% by 2025 does not appear to take into account all causes of NCDs. Its focus is on a few diseases, which are often linked with life-style factors with “voluntary” “modifiable behavioral risk factors” causes tending towards an over-simplification of the issues. We propose to add some aspects of our built environment related to hazardous building materials, and detailed form of the construction of infrastructure and buildings, which we think are some of the missing causes of NCDs. Some of these could be termed “involuntary causes”, as they relate to factors that are beyond the control of the general public. PMID:27690064

A systematic review of primary care models for non-communicable disease interventions in Sub-Saharan Africa.

PubMed

Kane, Jennifer; Landes, Megan; Carroll, Christopher; Nolen, Amy; Sodhi, Sumeet

2017-03-23

Chronic diseases, primarily cardiovascular disease, respiratory disease, diabetes and cancer, are the leading cause of death and disability worldwide. In sub-Saharan Africa (SSA), where communicable disease prevalence still outweighs that of non-communicable disease (NCDs), rates of NCDs are rapidly rising and evidence for primary healthcare approaches for these emerging NCDs is needed. A systematic review and evidence synthesis of primary care approaches for chronic disease in SSA. Quantitative and qualitative primary research studies were included that focused on priority NCDs interventions. The method used was best-fit framework synthesis. Three conceptual models of care for NCDs in low- and middle-income countries were identified and used to develop an a priori framework for the synthesis. The literature search for relevant primary research studies generated 3759 unique citations of which 12 satisfied the inclusion criteria. Eleven studies were quantitative and one used mixed methods. Three higher-level themes of screening, prevention and management of disease were derived. This synthesis permitted the development of a new evidence-based conceptual model of care for priority NCDs in SSA. For this review there was a near-consensus that passive rather than active case-finding approaches are suitable in resource-poor settings. Modifying risk factors among existing patients through advice on diet and lifestyle was a common element of healthcare approaches. The priorities for disease management in primary care were identified as: availability of essential diagnostic tools and medications at local primary healthcare clinics and the use of standardized protocols for diagnosis, treatment, monitoring and referral to specialist care.

Non-communicable diseases in the Asia-Pacific region: Prevalence, risk factors and community-based prevention.

PubMed

Low, Wah-Yun; Lee, Yew-Kong; Samy, Alexander Lourdes

2015-01-01

Non-communicable diseases (NCDs) lead to substantial mortality and morbidity worldwide. The most common NCDs are cardiovascular diseases (CVD), diabetes, cancer and chronic respiratory diseases. With the rapid increase in NCD-related deaths in Asia Pacific countries, NCDs are now the major cause of deaths and disease burden in the region. NCDs hamper achievement of the Millennium Development Goals (MDG). People in the low socio-economic group are most affected by NCDs as they have poor access to policies, legislations, regulations and healthcare services meant to combat NCDs. This results in loss of productivity by a decreasing labor force with implications at the macroeconomic level. The 3 major NCDs in the Asia Pacific region are CVDs, cancer and diabetes due to the increasing loss of disability adjusted life years (DALYs). The 4 major behavioral risk factors for NCDs are: tobacco use, alcohol consumption, inadequate physical activity and unhealthy diet. The underlying risk factors are urbanization, globalization, sedentary lifestyle, obesity and hypertension. Strategies to combat NCDs in the Asia Pacific region are as follows: population-based dietary salt reduction, health education, psychological interventions, i.e., cognitive behavioral therapy and motivational-interviewing, taxation and bans on tobacco-related advertisements, implementing smoke-free zones and surveillance by the World Health Organization. Control measures must focus on prevention and strengthening inter-sectorial collaboration. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Maternal and child health services and an integrated, life-cycle approach to the prevention of non-communicable diseases

PubMed Central

Brumana, Luisa; Arroyo, Alvaro; Schwalbe, Nina R; Lehtimaki, Susanna

2017-01-01

Described as the ‘invisible epidemic’, non-communicable diseases (NCDs) are the world’s leading cause of death. Most are caused by preventable factors, including poor diet, tobacco use, harmful use of alcohol and physical inactivity. Diabetes, cancer and cardiovascular and chronic lung diseases were responsible for 38 million (68%) of global deaths in 2012. Since 1990, proportionate NCD mortality has increased substantially as populations have aged and communicable diseases decline. The majority of NCD deaths, especially premature NCD deaths (<70 years, 82%), occur in low-income and middle-income countries, and among poor communities within them. Addressing NCDs is recognised as central to the post-2015 agenda; accordingly, NCDs have a specific objective and target in the Sustainable Development Goals. While deaths from NCDs occur mainly in adulthood, many have their origins in early life, including through epigenetic mechanisms operating before conception. Good nutrition before conception and interventions aimed at preventing NCDs during the first 1000 days (from conception to age 2 years), childhood and adolescence may be more cost-effective than managing established NCDs in later life with costly tests and drugs. Following a life-course approach, maternal and child health interventions, before delivery and during childhood and adolescence, can prevent NCDs and should influence global health and socioeconomic development. This paper describes how such an approach may be pursued, including through the engagement of non-health sectors. It also emphasises evaluating and documenting related initiatives to underwrite systematic and evidence-based cross-sectoral engagement on NCD prevention in the future. PMID:29082005

Non communicable disease and risky behaviour in an urban university community Nigeria.

PubMed

Ige, O K; Owoaje, E T; Adebiyi, O A

2013-03-01

Most developing countries have only limited information on the burden of Non Communicable Diseases (NCDs) even though rapid transitions in these NCDs have been predicted. To describe the burden of selected NCDs and associated risk behaviours in an urban university community in Nigeria. A cross-sectional survey of 525 representative staff of a University in a large city in Nigeria was conducted. In all, 27.6% were already diagnosed with at least one NCD (hypertension-21.5%, diabetes-11%, cancer 2.9%) while 67.4% reported at least one risk behaviour (unhealthy diet- 96%, sedentary living- 27.4% excessive alcohol use-5.1% and smoking- 1.9%). Multiple risk behaviours were observed in 29.9% with no significant variation by sex or age. Those 40 years and above had significantly higher prevalence of NCD, particularly for hypertension (p<0.05). Only 7%, considered themselves to be at risk of NCDs. Those whose parents had NCDs OR: 5.9 (2.4-14.5) and those who currently had NCDs OR: 3.9(1.8-8.1) perceived themselves at risk of one or more NCDs, but not those with multiple risk behaviours. The high burden of NCDs and risk behaviours in the face of limited self-perceived risk has been demonstrated and calls for urgent intervention.

Political priority in the global fight against non-communicable diseases.

PubMed

Maher, Anthony; Sridhar, Devi

2012-12-01

The prevalence of non-communicable diseases (NCDs) - such as cancer, diabetes, cardiovascular disease, and chronic respiratory diseases - is surging globally. Yet despite the availability of cost-effective interventions, NCDs receive less than 3% of annual development assistance for health to low and middle income countries. The top donors in global health - including the Bill and Melinda Gates Foundation, the US Government, and the World Bank - together commit less than 2% of their budgets to the prevention and control of NCDs. Why is there such meagre funding on the table for the prevention and control of NCDs? Why has a global plan of action aimed at halting the spread of NCDs been so difficult to achieve? This paper aims to tackle these two interrelated questions by analysing NCDs through the lens of Jeremy Shiffman's 2009 political priority framework. We define global political priority as 'the degree to which international and national political leaders actively give attention to an issue, and back up that attention with the provision of financial, technical, and human resources that are commensurate with the severity of the issue'. Grounded in social constructionism, this framework critically examines the relationship between agenda setting and 'objective' factors in global health, such as the existence of cost-effective interventions and a high mortality burden. From a methodological perspective, this paper fits within the category of discipline configurative case study. We support Shiffman's claim that strategic communication - or ideas in the form of issue portrayals - ought to be a core activity of global health policy communities. But issue portrayals must be the products of a robust and inclusive debate. To this end, we also consider it essential to recognise that issue portrayals reach political leaders through a vast array of channels. Raising the political priority of NCDs means engaging with the diverse ways in which actors express concern for the

Responding to non-communicable diseases in Zambia: a policy analysis.

PubMed

Mukanu, Mulenga M; Zulu, Joseph Mumba; Mweemba, Chrispin; Mutale, Wilbroad

2017-04-24

Non-communicable diseases (NCDs) are an emerging global health concern. Reports have shown that, in Zambia, NCDs are also an emerging problem and the government has begun initiating a policy response. The present study explores the policy response to NCDs by the Ministry of Health in Zambia using the policy triangle framework of Walt and Gilson. A qualitative approach was used for the study. Data collected through key informant interviews with stakeholders who were involved in the NCD health policy development process as well as review of key planning and policy documents were analysed using thematic analysis. The government's policy response was as a result of international strategies from WHO, evidence of increasing disease burden from NCDs and pressure from interest groups. The government developed the NCD strategic plan based on the WHO Global Action Plan for NCDs 2013-2030. Development of the NCD strategic plan was driven by the government through the Ministry of Health, who set the agenda and adopted the final document. Stakeholders participated in the fine tuning of the draft document from the Ministry of Health. The policy development process was lengthy and this affected consistency in composition of the stakeholders and policy development momentum. Lack of representative research evidence for some prioritised NCDs and use of generic targets and indicators resulted in the NCD strategic plan being inadequate for the Zambian context. The interventions in the strategic plan also underutilised the potential of preventing NCDs through health education. Recent government pronouncements were also seen to be conflicting the risk factor reduction strategies outlined in the NCD strategic plan. The content of the NCD strategic plan inadequately covered all the major NCDs in Zambia. Although contextual factors like international strategies and commitments are crucial catalysts to policy development, there is need for domestication of international guidelines and

National mortality burden due to communicable, non-communicable, and other diseases in Ethiopia, 1990-2015: findings from the Global Burden of Disease Study 2015.

PubMed

Misganaw, Awoke; Haregu, Tilahun N; Deribe, Kebede; Tessema, Gizachew Assefa; Deribew, Amare; Melaku, Yohannes Adama; Amare, Azmeraw T; Abera, Semaw Ferede; Gedefaw, Molla; Dessalegn, Muluken; Lakew, Yihunie; Bekele, Tolesa; Mohammed, Mesoud; Yirsaw, Biruck Desalegn; Damtew, Solomon Abrha; Krohn, Kristopher J; Achoki, Tom; Blore, Jed; Assefa, Yibeltal; Naghavi, Mohsen

2017-01-01

Ethiopia lacks a complete vital registration system that would assist in measuring disease burden and risk factors. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) estimates to describe the mortality burden from communicable, non-communicable, and other diseases in Ethiopia over the last 25 years. GBD 2015 mainly used cause of death ensemble modeling to measure causes of death by age, sex, and year for 195 countries. We report numbers of deaths and rates of years of life lost (YLL) for communicable, maternal, neonatal, and nutritional (CMNN) disorders, non-communicable diseases (NCDs), and injuries with 95% uncertainty intervals (UI) for Ethiopia from 1990 to 2015. CMNN causes of death have declined by 65% in the last two-and-a-half decades. Injury-related causes of death have also decreased by 70%. Deaths due to NCDs declined by 37% during the same period. Ethiopia showed a faster decline in the burden of four out of the five leading causes of age-standardized premature mortality rates when compared to the overall sub-Saharan African region and the Eastern sub-Saharan African region: lower respiratory infections, tuberculosis, HIV/AIDS, and diarrheal diseases; however, the same could not be said for ischemic heart disease and other NCDs. Non-communicable diseases, together, were the leading causes of age-standardized mortality rates, whereas CMNN diseases were leading causes of premature mortality in 2015. Although lower respiratory infections, tuberculosis, and diarrheal disease were the leading causes of age-standardized death rates, they showed major declines from 1990 to 2015. Neonatal encephalopathy, iron-deficiency anemia, protein-energy malnutrition, and preterm birth complications also showed more than a 50% reduction in burden. HIV/AIDS-related deaths have also decreased by 70% since 2005. Ischemic heart disease, hemorrhagic stroke, and ischemic stroke were among the top causes of premature mortality and age

National mortality burden due to communicable, non-communicable, and other diseases in Ethiopia, 1990-2015: findings from the Global Burden of Disease Study 2015.

PubMed

Misganaw, Awoke; Haregu, Tilahun N; Deribe, Kebede; Tessema, Gizachew Assefa; Deribew, Amare; Melaku, Yohannes Adama; Amare, Azmeraw T; Abera, Semaw Ferede; Gedefaw, Molla; Dessalegn, Muluken; Lakew, Yihunie; Bekele, Tolesa; Mohammed, Mesoud; Yirsaw, Biruck Desalegn; Damtew, Solomon Abrha; Krohn, Kristopher J; Achoki, Tom; Blore, Jed; Assefa, Yibeltal; Naghavi, Mohsen

2017-07-21

Ethiopia lacks a complete vital registration system that would assist in measuring disease burden and risk factors. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) estimates to describe the mortality burden from communicable, non-communicable, and other diseases in Ethiopia over the last 25 years. GBD 2015 mainly used cause of death ensemble modeling to measure causes of death by age, sex, and year for 195 countries. We report numbers of deaths and rates of years of life lost (YLL) for communicable, maternal, neonatal, and nutritional (CMNN) disorders, non-communicable diseases (NCDs), and injuries with 95% uncertainty intervals (UI) for Ethiopia from 1990 to 2015. CMNN causes of death have declined by 65% in the last two-and-a-half decades. Injury-related causes of death have also decreased by 70%. Deaths due to NCDs declined by 37% during the same period. Ethiopia showed a faster decline in the burden of four out of the five leading causes of age-standardized premature mortality rates when compared to the overall sub-Saharan African region and the Eastern sub-Saharan African region: lower respiratory infections, tuberculosis, HIV/AIDS, and diarrheal diseases; however, the same could not be said for ischemic heart disease and other NCDs. Non-communicable diseases, together, were the leading causes of age-standardized mortality rates, whereas CMNN diseases were leading causes of premature mortality in 2015. Although lower respiratory infections, tuberculosis, and diarrheal disease were the leading causes of age-standardized death rates, they showed major declines from 1990 to 2015. Neonatal encephalopathy, iron-deficiency anemia, protein-energy malnutrition, and preterm birth complications also showed more than a 50% reduction in burden. HIV/AIDS-related deaths have also decreased by 70% since 2005. Ischemic heart disease, hemorrhagic stroke, and ischemic stroke were among the top causes of premature mortality and age

The Challenge of Stress-Related Non-Communicable Diseases.

PubMed

Fricchione, Gregory L

2018-06-15

The greatest challenge facing medicine today involves the so-called non-communicable diseases (NCDs). This is true regardless of whether one's location is considered high-income, middle-income, or low-income. Basic research at all "OMICs" system levels will be significant in uncovering causal links that create NCD vulnerabilities in mind, brain, body, and society. Therefore, meeting this 21st century challenge by improving NCD management and prevention around the world will rely on advancement in this type of basic research.

The private sector, international development and NCDs

PubMed Central

2011-01-01

This article addresses an area that has been largely underserved by the development community, and one in which there is a particularly good opportunity for the private sector to take a lead in making a difference to employees, customers and local communities: chronic, non-communicable diseases (NCDs). It highlights the extent of the epidemic of NCDs in developing countries, sets out the 'business case' for the private sector to act on NCDs, and gives examples of initiatives by business to ensure that the healthy choice really is an easier choice for employees, consumers and local communities. It makes the case that, to be genuinely sustainable, businesses should be addressing health as a core part of what they do and, by working in partnership - as called for by the Millennium Development Goals - they can make a real difference and become part of the solution. Identifying ways in which this can be done should form a key part both of planning for, and action after, the UN High-level Meeting on NCDs, to be held in September 2011. PMID:21798001

Pharmacy workforce to prevent and manage non-communicable diseases in developing nations: The case of Nepal.

PubMed

Khanal, Saval; Nissen, Lisa; Veerman, Lennert; Hollingworth, Samantha

2016-01-01

Non-communicable diseases (NCDs, e.g. cardiovascular diseases, cancer, chronic respiratory diseases and diabetes mellitus) are the main causes of mortality and morbidity in developing countries, including Nepal. Nearly half of the deaths in Nepal are caused by NCDs. Nepal lacks adequate human resources to prevent and manage NCDs, but the skills and expertise of pharmacists in Nepal are underused. There is evidence from many countries that pharmacists can contribute substantially to the prevention and management NCD. We aim to describe the opportunities and challenges for pharmacists to prevent and manage NCDs in Nepal. Pharmacists can contribute by screening and monitoring NCDs; counseling on lifestyle; providing medication therapy management services; promoting public health; and providing other pharmaceutical services. Challenges to the implementation of some of these activities in the current context include inadequate training of pharmacists in NCD prevention and management, the cost of pharmaceutical services to patients and government, and the existing health care service delivery model. There is a need for health services research to determine how pharmacists can be best used to prevent and manage NCDs in Nepal. Copyright © 2015 Elsevier Inc. All rights reserved.

Public health impact of global heating due to climate change: potential effects on chronic non-communicable diseases.

PubMed

Kjellstrom, Tord; Butler, Ainslie J; Lucas, Robyn M; Bonita, Ruth

2010-04-01

Several categories of ill health important at the global level are likely to be affected by climate change. To date the focus of this association has been on communicable diseases and injuries. This paper briefly analyzes potential impacts of global climate change on chronic non-communicable diseases (NCDs). We reviewed the limited available evidence of the relationships between climate exposure and chronic and NCDs. We further reviewed likely mechanisms and pathways for climatic influences on chronic disease occurrence and impacts on pre-existing chronic diseases. There are negative impacts of climatic factors and climate change on some physiological functions and on cardio-vascular and kidney diseases. Chronic disease risks are likely to increase with climate change and related increase in air pollution, malnutrition, and extreme weather events. There are substantial research gaps in this arena. The health sector has a major role in facilitating further research and monitoring the health impacts of global climate change. Such work will also contribute to global efforts for the prevention and control of chronic NCDs in our ageing and urbanizing global population.

Autophagy and oxidative stress in non-communicable diseases: A matter of the inflammatory state?

PubMed

Peña-Oyarzun, Daniel; Bravo-Sagua, Roberto; Diaz-Vega, Alexis; Aleman, Larissa; Chiong, Mario; Garcia, Lorena; Bambs, Claudia; Troncoso, Rodrigo; Cifuentes, Mariana; Morselli, Eugenia; Ferreccio, Catterina; Quest, Andrew F G; Criollo, Alfredo; Lavandero, Sergio

2018-05-30

Non-communicable diseases (NCDs), also known as chronic diseases, are long-lasting conditions that affect millions of people around the world. Different factors contribute to their genesis and progression; however they share common features, which are critical for the development of novel therapeutic strategies. A persistently altered inflammatory response is typically observed in many NCDs together with redox imbalance. Additionally, dysregulated proteostasis, mainly derived as a consequence of compromised autophagy, is a common feature of several chronic diseases. In this review, we discuss the crosstalk among inflammation, autophagy and oxidative stress, and how they participate in the progression of chronic diseases such as cancer, cardiovascular diseases, obesity and type II diabetes mellitus. Copyright © 2018 Elsevier Inc. All rights reserved.

Looking Beyond the Terrestrial: The Potential of Seaweed Derived Bioactives to Treat Non-Communicable Diseases

PubMed Central

Collins, Kenneth G.; Fitzgerald, Gerald F.; Stanton, Catherine; Ross, R. Paul

2016-01-01

Seaweeds are a large and diverse group of marine organisms that are commonly found in the maritime regions of the world. They are an excellent source of biologically active secondary metabolites and have been shown to exhibit a wide range of therapeutic properties, including anti-cancer, anti-oxidant, anti-inflammatory and anti-diabetic activities. Several Asian cultures have a strong tradition of using different varieties of seaweed extensively in cooking as well as in herbal medicines preparations. As such, seaweeds have been used to treat a wide variety of health conditions such as cancer, digestive problems, and renal disorders. Today, increasing numbers of people are adopting a “westernised lifestyle” characterised by low levels of physical exercise and excessive calorific and saturated fat intake. This has led to an increase in numbers of chronic Non-communicable diseases (NCDs) such as cancer, cardiovascular disease, and diabetes mellitus, being reported. Recently, NCDs have replaced communicable infectious diseases as the number one cause of human mortality. Current medical treatments for NCDs rely mainly on drugs that have been obtained from the terrestrial regions of the world, with the oceans and seas remaining largely an untapped reservoir for exploration. This review focuses on the potential of using seaweed derived bioactives including polysaccharides, antioxidants and fatty acids, amongst others, to treat chronic NCDs such as cancer, cardiovascular disease and diabetes mellitus. PMID:26999166

Looking Beyond the Terrestrial: The Potential of Seaweed Derived Bioactives to Treat Non-Communicable Diseases.

PubMed

Collins, Kenneth G; Fitzgerald, Gerald F; Stanton, Catherine; Ross, R Paul

2016-03-18

Seaweeds are a large and diverse group of marine organisms that are commonly found in the maritime regions of the world. They are an excellent source of biologically active secondary metabolites and have been shown to exhibit a wide range of therapeutic properties, including anti-cancer, anti-oxidant, anti-inflammatory and anti-diabetic activities. Several Asian cultures have a strong tradition of using different varieties of seaweed extensively in cooking as well as in herbal medicines preparations. As such, seaweeds have been used to treat a wide variety of health conditions such as cancer, digestive problems, and renal disorders. Today, increasing numbers of people are adopting a "westernised lifestyle" characterised by low levels of physical exercise and excessive calorific and saturated fat intake. This has led to an increase in numbers of chronic Non-communicable diseases (NCDs) such as cancer, cardiovascular disease, and diabetes mellitus, being reported. Recently, NCDs have replaced communicable infectious diseases as the number one cause of human mortality. Current medical treatments for NCDs rely mainly on drugs that have been obtained from the terrestrial regions of the world, with the oceans and seas remaining largely an untapped reservoir for exploration. This review focuses on the potential of using seaweed derived bioactives including polysaccharides, antioxidants and fatty acids, amongst others, to treat chronic NCDs such as cancer, cardiovascular disease and diabetes mellitus.

Non-communicable diseases and human rights: Global synergies, gaps and opportunities.

PubMed

Ferguson, Laura; Tarantola, Daniel; Hoffmann, Michael; Gruskin, Sofia

2017-10-01

The incorporation of human rights in health policy and programmes is known to strengthen responses to health problems and help address disparities created or exacerbated by illness yet this remains underexplored in relation to non-communicable diseases (NCDs). Aiming to understand existing synergies and how they might be further strengthened, we assessed the extent to which human rights are considered in global NCD policies and strategies and the degree of attention given to NCDs by select United Nations human rights mechanisms. Across global NCD policies and strategies, rhetorical assertions regarding human rights appear more often than actionable statements, thus limiting their implementation and impact. Although no human rights treaty explicitly mentions NCDs, some human rights monitoring mechanisms have been paying increasing attention to NCDs. This provides important avenues for promoting the incorporation of human rights norms and standards into NCD responses as well as for accountability. Linking NCDs and human rights at the global level is critical for encouraging national-level action to promote better outcomes relating to both health and human rights. The post-2015 development agenda constitutes a key entry point for highlighting these synergies and strengthening opportunities for health and rights action at global, national and local levels.

Non-communicable diseases in Indian slums: re-framing the Social Determinants of Health.

PubMed

Lumagbas, Lily Beth; Coleman, Harry Laurence Selby; Bunders, Joske; Pariente, Antoine; Belonje, Anne; de Cock Buning, Tjard

2018-01-01

The epidemic of non-communicable diseases (NCDs) in slums has pushed its residents to heightened vulnerability. The Social Determinants of Health (SDH) framework has been used to understand the social dynamics and impact of NCDs, especially in poorly resourced communities. Whilst the SDH has helped to discredit the characterisation of NCDs as diseases of affluence, its impact on policy has been less definite. Given the multitude of factors that interact in the presentation of NCDs, operationalising the SDH for policies and programmes that account for the contextual complexity of slums has stalled. To organise the complex networks of relations between SDH in slums so as to identify options for Indian municipal policy that are feasible to implement in the short term. The study reviews the literature describing SDH in Indian slums, specifically those that establish causal relations between SDH and NCDs. Root cause analysis was then used to organise the identified relations of SDH and NCDs. Although poverty remains the largest structural determinant of health in slums, the multi-dimensional relations between SDH and NCDs are structured around four themes that describe the dynamics of slums, namely scarce clean water, low education, physical (in)activity and transportation. From the reviewed literature, four logic trees visualising the relations between SDH in slums and NCDs were constructed. The logic trees separate symptomatic problems from their more distal causes, and recommendations were formulated based on features of these relationships that are amenable to policy intervention. Root cause analysis provides a means to focus the lens of examination of SDH, as evidenced here for Indian slums. It provides a guide for the development of policies that are grounded in the actual health concerns of people in slums, and takes account of the complex pathways through which diseases are socially constituted.

Research needs for an improved primary care response to chronic non-communicable diseases in Africa.

PubMed

Maher, D; Sekajugo, J; Harries, A D; Grosskurth, H

2010-02-01

With non-communicable diseases (NCDs) projected to become leading causes of morbidity and mortality in developing countries, research is needed to improve the primary care response, especially in sub-Saharan Africa. This region has a particularly high double burden of communicable diseases and NCDs and the least resources for an effective response. There is a lack of good quality epidemiological data from diverse settings on chronic NCD burden in sub-Saharan Africa, and the approach to primary care of people with chronic NCDs is currently often unstructured. The main primary care research needs are therefore firstly, epidemiological research to document the burden of chronic NCDs, and secondly, health system research to deliver the structured, programmatic, public health approach that has been proposed for the primary care of people with chronic NCDs. Documentation of the burden and trends of chronic NCDs and associated risk factors in different settings and different population groups is needed to enable health system planning for an improved primary care response. Key research issues in implementing the programmatic framework for an improved primary care response are how to (i) integrate screening and prevention within health delivery; (ii) validate the use of standard diagnostic protocols for NCD case-finding among patients presenting to the local health facilities; (iii) improve the procurement and provision of standardised treatment and (iv) develop and implement a data collection system for standardised monitoring and evaluation of patient outcomes. Important research considerations include the following: selection of research sites and the particular NCDs targeted; research methodology; local research capacity; research collaborations; ethical issues; translating research findings into policy and practice and funding. Meeting the research needs for an improved health system response is crucial to deliver effective, affordable and equitable care for the

Health system challenges of NCDs in Tunisia.

PubMed

Ben Romdhane, Habiba; Tlili, Faten; Skhiri, Afef; Zaman, Shahaduz; Phillimore, Peter

2015-01-01

The objective of this study was to present a qualitative 'situation analysis' of the healthcare system in Tunisia, as it applies to management of cardiovascular disease (CVD) and diabetes. A primary concern was the institutional capacity to manage non-communicable diseases (NCDs). Research took place during 2010 (analysis of official documents, semi-structured interviews with key informants, and case studies in four clinics). Walt and Gilson's framework (1994) for policy analysis was used: content, actors, context, and process. Problems of integration and coordination have compounded funding pressures. Despite its importance in Tunisian healthcare, primary health is ill-equipped to manage NCDs. With limited funds, and no referral or health information system, staff morale in the public sector was low. Private healthcare has been the main development filling the void. This study highlights major gaps in the implementation of a comprehensive approach to NCDs, which is an urgent task across the region. In strategic planning, research on the health system is vital; but the capacity within Ministries of Health to use research has first to be built, with a commitment to grounding policy change in evidence.

Chinese new immigrant mothers' perception about adult-onset non-communicable diseases prevention during childhood.

PubMed

Wang, Linda Dong Ling; Lam, Wendy Wing Tak; Wu, Joseph Tsz Kei; Fielding, Richard

2015-12-01

Many non-communicable diseases (NCDs) are largely preventable via behaviour change and healthy lifestyle, which may be best established during childhood. This study sought insights into Chinese new immigrant mothers' perceptions about adult-onset NCDs prevention during childhood. Twenty-three semi-structured interviews were carried out with new immigrant mothers from mainland China who had at least one child aged 14 years or younger living in Hong Kong. Interviews were audio taped, transcribed and analysed using a Grounded Theory approach. The present study identified three major themes: perceived causes of adult NCDs, beliefs about NCDs prevention and everyday health information practices. Unhealthy lifestyle, contaminated food and environment pollution were perceived as the primary causes of adult NCDs. Less than half of the participants recognized that parents had responsibility for helping children establish healthy behaviours from an early age to prevent diseases in later life. Most participants expressed helplessness about chronic diseases prevention due to lack of knowledge of prevention, being perceived as beyond individual control. Many participants experienced barriers to seeking health information, the most common sources of health information being interpersonal conversation and television. Participants' everyday information practice was passive and generally lacked awareness regarding early prevention of adult-onset NCDs. Updated understanding of this issue has notable implications for future health promotion interventions. © The Author (2014). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Educational status and beliefs regarding non-communicable diseases among children in Ghana.

PubMed

Badasu, Delali M; Abuosi, Aaron A; Adzei, Francis A; Anarfi, John K; Yawson, Alfred E; Atobrah, Deborah A

2018-03-05

Increasing prevalence of non-communicable diseases (NCDs) has been observed in Ghana as in other developing countries. Past research focused on NCDs among adults. Recent researches, however, provide evidence on NCDs among children in many countries, including Ghana. Beliefs about the cause of NCDs among children may be determined by the socioeconomic status of parents and care givers. This paper examines the relationship between educational status of parents and/or care givers of children with NCDs on admission and their beliefs regarding NCDs among children. A total of 225 parents and/or care givers of children with NCDS hospitalized in seven hospitals in three regions (Greater Accra, Ashanti and Volta) were selected for the study. Statistical techniques, including the chi-square and multinomial logistic regression, were used for the data analysis. Educational status is a predictor of care giver's belief about whether enemies can cause NCDs among children or not. This is the only belief with which all the educational categories have significant relationship. Also, post-secondary/polytechnic (p-value =0.029) and university (p-value = 0.009) levels of education are both predictors of care givers being undecided about the belief that NCDs among children can be caused by enemies, when background characteristics are controlled for. Significant relationship is found between only some educational categories regarding the other types of beliefs and NCDs among children. For example, those with Middle/Juniour Secondary School (JSS)/Juniour High School (JHS) education are significantly undecided about the belief that the sin of parents can cause NCDs among children. Education is more of a predictor of the belief that enemies can cause NCDs among children than the other types of beliefs. Some categories of ethnicity, residential status and age have significant relationship with the beliefs when background characteristics of the parents and/or care givers were controlled

Non-communicable diseases, infection and survival in a retrospective cohort of Indigenous and non-Indigenous adults in central Australia

PubMed Central

Einsiedel, Lloyd; Fernandes, Liselle; Joseph, Sheela; Brown, Alex; Woodman, Richard J

2013-01-01

Objectives We hypothesise that rising prevalence rates of non-communicable diseases (NCDs) increase infection risk and worsen outcomes among socially disadvantaged Indigenous Australians undergoing a rapid epidemiological transition. Design Available pathology, imaging and discharge morbidity codes were retrospectively reviewed for a period of 5 years prior to admission with a bloodstream infection (BSI), 1 January 2003 to 30 June 2007. Participants 558 Indigenous and 55 non-Indigenous community residents of central Australia. Outcome measures The effects of NCDs on risk of infection and death were determined after stratifying by ethnicity. Results The mean annual BSI incidence rates were far higher among Indigenous residents (Indigenous, 937/100 000; non-Indigenous, 64/100 000 person-years; IRR=14.6; 95% CI 14.61 to 14.65, p<0.001). Indigenous patients were also more likely to have previous bacterial infections (68.7% vs 34.6%; respectively, p<0.001), diabetes (44.3% vs 20%; p<0.001), harmful alcohol consumption (37% vs 12.7%; p<0.001) and other communicable diseases (human T-lymphotropic virus type 1, 45.2%; strongyloidiasis, 36.1%; hepatitis B virus, 12.9%). Among Indigenous patients, diabetes increased the odds of current Staphylococcus aureus BSI (OR=1.6, 95% CI 1.0 to 2.5) and prior skin infections (adjusted OR=2.1, 95% CI 1.4 to 3.3). Harmful alcohol consumption increased the odds of current Streptococcus pneumoniae BSI (OR=1.57, 95% CI 1.02 to 2.40) and of previous BSI (OR=1.7, 95% CI 1.1 to 2.5), skin infection (OR=1.7, 95% CI 1.1 to 2.6) or pneumonia (OR=4.3, 95% CI 2.8 to 6.7). Twenty-six per cent of Indigenous patients died at a mean (SD) age of 47±15 years. Complications of diabetes and harmful alcohol consumption predicted 28-day mortality (non-rheumatic heart disease, HR=2.9; 95% CI 1.4 to 6.2; chronic renal failure, HR=2.6, 95%CI 1.0 to 6.5; chronic liver disease, HR=3.3, 95% CI 1.6 to 6.7). Conclusions In a socially disadvantaged

Non-communicable diseases among children in Ghana: health and social concerns of parent/caregivers.

PubMed

Yawson, Alfred E; Abuosi, Aaron A; Badasu, Delali M; Atobra, Deborah; Adzei, Francis A; Anarfi, John K

2016-06-01

Globally, there is a progressive rise in the burden of non-communicable diseases (NCDs). This paper examined the health and social concerns of parents/caregivers on in-patient care for children with NCDs in Ghana. This was a cross-sectional study in three large health facilities in Ghana (the largest in the South, the largest in the North and the largest in the Eastern part of Ghana. Data was collected with a structured questionnaire among 225 caregivers (≥18 years) of 149 children with NCDs in health facilities in the three regions. Data was analyzed with simple descriptive statistics. Most caregivers 169(75.0%) were women, relatively young (median age 35years), mostly married and resided in urban areas. Sickle cell disease was the commonest NCD among the children. All 169(75.0%) caregivers believed children suffer NCDs because of sins of parents/ancestors, 29(12.9%) believed herbalists/spiritualists have insights into treating NCDs and 73(32.6%) have previously used herbs/traditional medicine for child's illness. NCD in children was a burden and caused financial difficulties for families. Most caregivers (>96.0%) indicated NCDs in children should be included in national health insurance benefits package and a comprehensive national NCD policy is needed. Absence of national NCD policy for children is a major challenge. The burden of care rests mainly on the parents/caregivers. A national strategic intervention on the importance of awareness generation on the causes, risk factors, prevention and treatment of NCDs for families and communities is essential. Government support through national health and social policy initiatives are essential.

Quality of care for patients with non-communicable diseases in the Dedza District, Malawi

PubMed Central

Wood, Rachel; Der Merwe, Lisa Van; Mash, Robert

2015-01-01

Introduction In Malawi, non-communicable diseases (NCDs) are thought to cause 28% of deaths in adults. The aim of this study was to establish the extent of primary care morbidity related to NCDs, as well as to audit the quality of care, in the primary care setting of Dedza District, central Malawi. Methods This study was a baseline audit using clinic registers and a questionnaire survey of senior health workers at 5 clinics, focusing on care for hypertension, diabetes, asthma and epilepsy Results A total of 82 581 consultations were recorded, of which 2489 (3.0%) were for the selected NCDs. Only 5 out of 32 structural criteria were met at all 5 clinics and 9 out of 29 process criteria were never performed at any clinic. The only process criteria performed at all five clinics was measurement of blood pressure. The staff's knowledge on NCDs was basic and the main barriers to providing quality care were lack of medication and essential equipment, inadequate knowledge and guidelines, fee-for-service at two clinics, geographic inaccessibility and lack of confidence in the primary health care system by patients. Conclusion Primary care morbidity from NCDs is currently low, although other studies suggest a significant burden of disease. This most likely represents a lack of utilisation, recognition, diagnosis and ability to manage patients with NCDs. Quality of care is poor due to a lack of essential resources, guidelines, and training. PMID:26245609

Non-communicable diseases and adherence to Mediterranean diet.

PubMed

Caretto, Antonio; Lagattolla, Valeria

2015-01-01

Non-communicable diseases (NCDs) also known as chronic diseases last for a long time and progress generally slow. Major non-communicable diseases are cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. Unhealthy lifestyles and food behaviours play an important role for determining such diseases. The change in unhealthy behaviours or the maintenance of healthy lifestyles has enormous value in the reduction of diseases and longer life expectancy not only on an individual level but for the community as a whole. Recent meta-analyses reported Mediterranean diet to be an optimal diet when adopted as a whole, in order to preserve and maintain a good health status. A greater adherence score to the Mediterranean diet (2-point increase) was related to induce an 8% reduction in overall mortality, a 10% reduced risk of CVD and a 4% reduction in neoplastic diseases. However, there is no direct method in quantifying and evaluating adherence, therefore a large number of indirect indices in several studies have been proposed, with a last unifying score. Recently more and more e-health techniques such as web communication or desktop publishing (DVDs and so on) are being used, obtaining good results in the Mediterranean diet adherence. For successfully changing the unhealthy lifestyles and food behaviours of the population, interventions at all levels are needed with the cooperation of Institutions, mass media, agricultural and food industry and healthcare professionals guided by expert scientific societies.

Untapped aspects of mass media campaigns for changing health behaviour towards non-communicable diseases in Bangladesh.

PubMed

Tabassum, Reshman; Froeschl, Guenter; Cruz, Jonas P; Colet, Paolo C; Dey, Sukhen; Islam, Sheikh Mohammed Shariful

2018-01-18

In recent years, non-communicable diseases (NCDs) have become epidemic in Bangladesh. Behaviour changing interventions are key to prevention and management of NCDs. A great majority of people in Bangladesh have low health literacy, are less receptive to health information, and are unlikely to embrace positive health behaviours. Mass media campaigns can play a pivotal role in changing health behaviours of the population. This review pinpoints the role of mass media campaigns for NCDs and the challenges along it, whilst stressing on NCD preventive programmes (with the examples from different countries) to change health behaviours in Bangladesh. Future research should underpin the use of innovative technologies and mobile phones, which might be a prospective option for NCD prevention and management in Bangladesh.

Integrating Oral Health with Non-Communicable Diseases as an Essential Component of General Health: WHO's Strategic Orientation for the African Region.

PubMed

Varenne, Benoit

2015-05-01

In the context of the emerging recognition of non-communicable diseases (NCDs), it has never been more timely to explore the World Health Organization (WHO) strategic orientations on oral health in the WHO African region and to raise awareness of a turning point in the search for better oral health for everyone. The global initiative against NCDs provides a unique opportunity for the oral health community to develop innovative policies for better recognition of oral health, as well as to directly contribute to the fight against NCDs and their risk factors. The WHO African region has led the way in developing the first regional oral health strategy for the prevention and control of oral diseases integrated with NCDs. The support of the international oral health community in this endeavor is urgently needed for making a success story of this initiative of integrating oral health into NCDs.

A systematic review of randomized controlled trials of mHealth interventions against non-communicable diseases in developing countries.

PubMed

Stephani, Victor; Opoku, Daniel; Quentin, Wilm

2016-07-15

The reasons of deaths in developing countries are shifting from communicable diseases towards non-communicable diseases (NCDs). At the same time the number of health care interventions using mobile phones (mHealth interventions) is growing rapidly. We review studies assessing the health-related impacts of mHealth on NCDs in low- and middle-income countries (LAMICs). A systematic literature search of three major databases was performed in order to identify randomized controlled trials (RCTs) of mHealth interventions. Identified studies were reviewed concerning key characteristics of the trial and the intervention; and the relationship between intervention characteristics and outcomes was qualitatively assessed. The search algorithms retrieved 994 titles. 8 RCTs were included in the review, including a total of 4375 participants. Trials took place mostly in urban areas, tested different interventions (ranging from health promotion over appointment reminders and medication adjustments to clinical decision support systems), and included patients with different diseases (diabetes, asthma, hypertension). Except for one study all showed rather positive effects of mHealth interventions on reported outcome measures. Furthermore, our results suggest that particular types of mHealth interventions that were found to have positive effects on patients with communicable diseases and for improving maternal care are likely to be effective also for NCDs. Despite rather positive results of included RCTs, a firm conclusion about the effectiveness of mHealth interventions against NCDs is not yet possible because of the limited number of studies, the heterogeneity of evaluated mHealth interventions and the wide variety of reported outcome measures. More research is needed to better understand the specific effects of different types of mHealth interventions on different types of patients with NCDs in LaMICs.

The global impact of non-communicable diseases on healthcare spending and national income: a systematic review.

PubMed

Muka, Taulant; Imo, David; Jaspers, Loes; Colpani, Veronica; Chaker, Layal; van der Lee, Sven J; Mendis, Shanthi; Chowdhury, Rajiv; Bramer, Wichor M; Falla, Abby; Pazoki, Raha; Franco, Oscar H

2015-04-01

The impact of non-communicable diseases (NCDs) in populations extends beyond ill-health and mortality with large financial consequences. To systematically review and meta-analyze studies evaluating the impact of NCDs (including coronary heart disease, stroke, type 2 diabetes mellitus, cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease and chronic kidney disease) at the macro-economic level: healthcare spending and national income. Medical databases (Medline, Embase and Google Scholar) up to November 6th 2014. For further identification of suitable studies, we searched reference lists of included studies and contacted experts in the field. We included randomized controlled trials, systematic reviews, cohorts, case-control, cross-sectional, modeling and ecological studies carried out in adults assessing the economic consequences of NCDs on healthcare spending and national income without language restrictions. All abstracts and full text selection was done by two independent reviewers. Any disagreements were resolved through consensus or consultation of a third reviewer. Data were extracted by two independent reviewers using a pre-designed data collection form. Studies evaluating the impact of at least one of the selected NCDs on at least one of the following outcome measures: healthcare expenditure, national income, hospital spending, gross domestic product (GDP), gross national product, net national income, adjusted national income, total costs, direct costs, indirect costs, inpatient costs, outpatient costs, per capita healthcare spending, aggregate economic outcome, capital loss in production levels in a country, economic growth, GDP per capita (per capita income), percentage change in GDP, intensive growth, extensive growth, employment, direct governmental expenditure and non-governmental expenditure. From 4,364 references, 153 studies met our inclusion criteria. Most of the studies were focused on healthcare related costs of NCDs

Exploring the potential for using results-based financing to address non-communicable diseases in low- and middle-income countries

PubMed Central

2013-01-01

Background The burden of disease due to non-communicable diseases (NCDs) is rising in low- and middle-income countries (LMICs) and funding for global health is increasingly limited. As a large contributor of development assistance for health, the US government has the potential to influence overall trends in NCDs. Results-based financing (RBF) has been proposed as a strategy to increase aid effectiveness and efficiency through incentives for positive performance and results in health programs, but its potential for addressing NCDs has not been explored. Methods Qualitative methods including literature review and key informant interviews were used to identify promising RBF mechanisms for addressing NCDs in resource-limited settings. Eight key informants identified by area of expertise participated in semi-structured interviews. Results The majority of RBF schemes to date have been applied to maternal and child health. Evidence from existing RBF programs suggests that RBF principles can be applied to health programs for NCDs. Several options were identified for US involvement with RBF for NCDs. Conclusion There is potential for the US to have a significant impact on NCDs in LMICs through a comprehensive RBF strategy for global health. RBF mechanisms should be tested for use in NCD programs through pilot programs incorporating robust impact evaluations. PMID:23368959

Exploring the potential for using results-based financing to address non-communicable diseases in low- and middle-income countries.

PubMed

Beane, Chelsey R; Hobbs, Suzanne Havala; Thirumurthy, Harsha

2013-02-01

The burden of disease due to non-communicable diseases (NCDs) is rising in low- and middle-income countries (LMICs) and funding for global health is increasingly limited. As a large contributor of development assistance for health, the US government has the potential to influence overall trends in NCDs. Results-based financing (RBF) has been proposed as a strategy to increase aid effectiveness and efficiency through incentives for positive performance and results in health programs, but its potential for addressing NCDs has not been explored. Qualitative methods including literature review and key informant interviews were used to identify promising RBF mechanisms for addressing NCDs in resource-limited settings. Eight key informants identified by area of expertise participated in semi-structured interviews. The majority of RBF schemes to date have been applied to maternal and child health. Evidence from existing RBF programs suggests that RBF principles can be applied to health programs for NCDs. Several options were identified for US involvement with RBF for NCDs. There is potential for the US to have a significant impact on NCDs in LMICs through a comprehensive RBF strategy for global health. RBF mechanisms should be tested for use in NCD programs through pilot programs incorporating robust impact evaluations.

Impacts of chronic non-communicable diseases on households' out-of-pocket healthcare expenditures in Sri Lanka.

PubMed

Pallegedara, Asankha

2018-01-10

This article examines the effects of chronic non-communicable diseases (NCDs) on households' out-of-pocket health expenditures in Sri Lanka. We explore the disease specific impacts on out-of-pocket health care expenses from chronic NCDs such as heart diseases, hypertension, cancer, diabetics and asthma. We use nationwide cross-sectional household income and expenditure survey 2012/2013 data compiled by the department of census and statistics of Sri Lanka. Employing propensity score matching method to account for selectivity bias, we find that chronic NCD affected households appear to spend significantly higher out-of-pocket health care expenditures and encounter grater economic burden than matched control group despite having universal public health care policy in Sri Lanka. The results also suggest that out-of-pocket expenses on medicines and other pharmaceutical products as well as expenses on medical laboratory tests and other ancillary services are particularly higher for households with chronic NCD patients. The findings underline the importance of protecting households against the financial burden due to NCDs.

Effect of mHealth on modifying behavioural risk-factors of non-communicable diseases in an adult, rural population in Delhi, India.

PubMed

Sharma, Malvika; Banerjee, Bratati; Ingle, G K; Garg, Suneela

2017-01-01

The rising trend of non-communicable diseases (NCDs) has led to a "dual burden" in low and middle-income (LAMI) countries like India which are still battling with high prevalence of communicable diseases. The incorporation of a target specially dedicated to NCDs within the goal 3 of the newly adopted Sustainable Development Goals indicates the importance the world now accords to prevention and control of these diseases. Mobile phone technology is increasingly viewed as a promising communication channel that can be utilized for primary prevention of NCDs by promoting behaviour change and risk factor modification. A "Before and After" Intervention study was conducted on 400 subjects, over a period of one year, in Barwala village, Delhi, India. An mHealth intervention package consisting of weekly text messages and monthly telephone calls addressing lifestyle modification for risk factors of NCDs was given to the intervention group, compared to no intervention package in control group. After Intervention Phase, significant reduction was seen in behavioural risk factors (unhealthy diet and insufficient physical activity) in the intervention group compared to control group. Body mass index (BMI), systolic blood pressure and fasting blood sugar level also showed significant difference in the intervention group as compared to controls. Our study has demonstrated the usefulness of mHealth for health promotion and lifestyle modification at community level in a LAMI country. With the growing burden of NCDs in the community, such cost effective and innovative measures will be needed that can easily reach the masses.

Shining a Light on Task-Shifting Policy: Exploring opportunities for adaptability in non-communicable disease management programmes in Uganda.

PubMed

Katende, Godfrey; Donnelly, Mary

2016-05-01

In terms of disease burden, many low- and middle-income countries are currently experiencing a transition from infectious to chronic diseases. In Uganda, non-communicable diseases (NCDs) have increased significantly in recent years; this challenge is compounded by the healthcare worker shortage and the underfunded health system administration. Addressing the growing prevalence of NCDs requires evidence-based policies and strategies to reduce morbidity and mortality rates; however, the integration and evaluation of new policies and processes pose many challenges. Task-shifting is the process whereby specific tasks are transferred to health workers with less training and fewer qualifications. Successful implementation of a task-shifting policy requires appropriate skill training, clearly defined roles, adequate evaluation, an enhanced training capacity and sufficient health worker incentives. This article focuses on task-shifting policy as a potentially effective strategy to address the growing burden of NCDs on the Ugandan healthcare system.

Tackling socioeconomic inequalities and non-communicable diseases in low-income and middle-income countries under the Sustainable Development agenda.

PubMed

Niessen, Louis W; Mohan, Diwakar; Akuoku, Jonathan K; Mirelman, Andrew J; Ahmed, Sayem; Koehlmoos, Tracey P; Trujillo, Antonio; Khan, Jahangir; Peters, David H

2018-05-19

Five Sustainable Development Goals (SDGs) set targets that relate to the reduction of health inequalities nationally and worldwide. These targets are poverty reduction, health and wellbeing for all, equitable education, gender equality, and reduction of inequalities within and between countries. The interaction between inequalities and health is complex: better economic and educational outcomes for households enhance health, low socioeconomic status leads to chronic ill health, and non-communicable diseases (NCDs) reduce income status of households. NCDs account for most causes of early death and disability worldwide, so it is alarming that strong scientific evidence suggests an increase in the clustering of non-communicable conditions with low socioeconomic status in low-income and middle-income countries since 2000, as previously seen in high-income settings. These conditions include tobacco use, obesity, hypertension, cancer, and diabetes. Strong evidence from 283 studies overwhelmingly supports a positive association between low-income, low socioeconomic status, or low educational status and NCDs. The associations have been differentiated by sex in only four studies. Health is a key driver in the SDGs, and reduction of health inequalities and NCDs should become key in the promotion of the overall SDG agenda. A sustained reduction of general inequalities in income status, education, and gender within and between countries would enhance worldwide equality in health. To end poverty through elimination of its causes, NCD programmes should be included in the development agenda. National programmes should mitigate social and health shocks to protect the poor from events that worsen their frail socioeconomic condition and health status. Programmes related to universal health coverage of NCDs should specifically target susceptible populations, such as elderly people, who are most at risk. Growing inequalities in access to resources for prevention and treatment need to

Investing in non-communicable disease prevention and management to advance the Sustainable Development Goals.

PubMed

Nugent, Rachel; Bertram, Melanie Y; Jan, Stephen; Niessen, Louis W; Sassi, Franco; Jamison, Dean T; Pier, Eduardo González; Beaglehole, Robert

2018-05-19

Reduction of the non-communicable disease (NCD) burden is a global development imperative. Sustainable Development Goal (SDG) 3 includes target 3·4 to reduce premature NCD mortality by a third by 2030. Progress on SDG target 3·4 will have a central role in determining the success of at least nine SDGs. A strengthened effort across multiple sectors with effective economic tools, such as price policies and insurance, is necessary. NCDs are heavily clustered in people with low socioeconomic status and are an important cause of medical impoverishment. They thereby exacerbate economic inequities within societies. As such, NCDs are a barrier to achieving SDG 1, SDG 2, SDG 4, SDG 5, and SDG 10. Productivity gains from preventing and managing NCDs will contribute to SDG 8. SDG 11 and SDG 12 offer clear opportunities to reduce the NCD burden and to create sustainable and healthy cities. Copyright © 2018 Elsevier Ltd. All rights reserved.

Sleeping with the enemy: the United Nations Development Programme and its position on the non-communicable disease epidemic.

PubMed

Jacob, Anil G; Lal, Pranay G; Buragohain, Anita

2014-02-01

The United Nations Development Programme's (UNDP) position on non-communicable diseases (NCDs) is undermined by a key issue at the global institutional level. Fundamentally, the nature of the relationship between international development agencies and the tobacco industry is at odds with the professed public health priorities of the former. At its core, the business model of the tobacco industry is premised on the sale of addictive and disease-causing substances that fuel NCDs in the first place. The role of the United Nations system and, in particular, UNDP is to 'build nations that can withstand crisis', not to collaborate with entities that profit from crises. This simple and well-established fact cannot be overlooked. We outline an array of conflict of interests. If the effects of NCDs are ever to be reversed, then international agencies such as the UNDP ought to adhere to ethical standards in choosing partners and avoid conflict of interests. In the absence of this, the UNDP may well compromise its own agenda and proliferate NCDs rather than containing them. © 2014 John Wiley & Sons Ltd.

Patent and exclusivity status of essential medicines for non-communicable disease.

PubMed

Mackey, Tim K; Liang, Bryan A

2012-01-01

The threat of non-communicable diseases ("NCDs") is increasingly becoming a global health crisis and are pervasive in high, middle, and low-income populations resulting in an estimated 36 million deaths per year. There is a need to assess intellectual property rights ("IPRs") that may impede generic production and availability and affordability to essential NCD medicines. Using the data sources listed below, the study design systematically eliminated NCD drugs that had no patent/exclusivity provisions on API, dosage, or administration route. The first step identified essential medicines that treat certain high disease burden NCDs. A second step examined the patent and exclusivity status of active ingredient, dosage and listed route of administration using exclusion criteria outlined in this study. We examined the patent and exclusivity status of medicines listed in the World Health Organization's ("WHO") Model List of Essential Drugs (Medicines) ("MLEM") and other WHO sources for drugs treating certain NCDs. i.e., cardiovascular and respiratory disease, cancers, and diabetes. We utilized the USA Food and Drug Administration Orange Book and the USA Patent and Trademark Office databases as references given the predominant number of medicines registered in the USA. Of the 359 MLEM medicines identified, 22% (79/359) address targeted NCDs. Of these 79, only eight required in-depth patent or exclusivity assessment. Upon further review, no NCD MLEM medicines had study patent or exclusivity protection for reviewed criteria. We find that ensuring availability and affordability of potential generic formulations of NCD MLEM medicines appears to be more complex than the presence of IPRs with API, dosage, or administration patent or exclusivity protection. Hence, more sophisticated analysis of NCD barriers to generic availability and affordability should be conducted in order to ensure equitable access to global populations for these essential medicines.

Prevalence and risk factors for self-reported non-communicable diseases among older Ugandans: a cross-sectional study

PubMed Central

Wandera, Stephen Ojiambo; Kwagala, Betty; Ntozi, James

2015-01-01

Background There is limited evidence about the prevalence and risk factors for non-communicable diseases (NCDs) among older Ugandans. Therefore, this article is aimed at investigating the prevalence of self-reported NCDs and their associated risk factors using a nationally representative sample. Design We conducted a secondary analysis of the 2010 Uganda National Household Survey (UNHS) using a weighted sample of 2,382 older people. Frequency distributions for descriptive statistics and Pearson chi-square tests to identify the association between self-reported NCDs and selected explanatory variables were done. Finally, multivariable complementary log–log regressions to estimate the risk factors for self-reported NCDs among older people in Uganda were done. Results About 2 in 10 (23%) older persons reported at least one NCD [including hypertension (16%), diabetes (3%), and heart disease (9%)]. Among all older people, reporting NCDs was higher among those aged 60–69 and 70–79; Muslims; and Pentecostals and Seventh Day Adventists (SDAs). In addition, the likelihood of reporting NCDs was higher among older persons who depended on remittances and earned wages; owned a bicycle; were sick in the last 30 days; were disabled; and were women. Conversely, the odds of reporting NCDs were lower for those who were relatives of household heads and were poor. Conclusions In Uganda, self-reported NCDs were associated with advanced age, being a woman, having a disability, ill health in the past 30 days, being rich, depended on remittances and earning wages, being Muslim, Pentecostal and SDAs, and household headship. The Ministry of Health should prevent and manage NCDs by creating awareness in the public and improving the supply of essential drugs for these health conditions. Finally, there is a need for specialised surveillance studies of older people to monitor the trends and patterns of NCDs over time. PMID:26205363

Medicalization of global health 3: the medicalization of the non-communicable diseases agenda.

PubMed

Clark, Jocalyn

2014-01-01

There is growing recognition of the massive global burden of non-communicable diseases (NCDs) due to their prevalence, projected social and economic costs, and traditional neglect compared to infectious disease. The 2011 UN Summit, WHO 25×25 targets, and support of major medical and advocacy organisations have propelled prominence of NCDs on the global health agenda. NCDs are by definition 'diseases' so already medicalized. But their social drivers and impacts are acknowledged, which demand a broad, whole-of-society approach. However, while both individual- and population-level targets are identified in the current NCD action plans, most recommended strategies tend towards the individualistic approach and do not address root causes of the NCD problem. These so-called population strategies risk being reduced to expectations of individual and behavioural change, which may have limited success and impact and deflect attention away from government policies or regulation of industry. Industry involvement in NCD agenda-setting props up a medicalized approach to NCDs: food and drink companies favour focus on individual choice and responsibility, and pharmaceutical and device companies favour calls for expanded access to medicines and treatment coverage. Current NCD framing creates expanded roles for physicians, healthcare workers, medicines and medical monitoring. The professional rather than the patient view dominates the NCD agenda and there is a lack of a broad, engaged, and independent NGO community. The challenge and opportunity lie in defining priorities and developing strategies that go beyond a narrow medicalized framing of the NCD problem and its solutions.

Country actions to meet UN commitments on non-communicable diseases: a stepwise approach.

PubMed

Bonita, Ruth; Magnusson, Roger; Bovet, Pascal; Zhao, Dong; Malta, Deborah C; Geneau, Robert; Suh, Il; Thankappan, Kavumpurathu Raman; McKee, Martin; Hospedales, James; de Courten, Maximilian; Capewell, Simon; Beaglehole, Robert

2013-02-16

Strong leadership from heads of state is needed to meet national commitments to the UN political declaration on non-communicable diseases (NCDs) and to achieve the goal of a 25% reduction in premature NCD mortality by 2025 (the 25 by 25 goal). A simple, phased, national response to the political declaration is suggested, with three key steps: planning, implementation, and accountability. Planning entails mobilisation of a multisectoral response to develop and support the national action plan, and to build human, financial, and regulatory capacity for change. Implementation of a few priority and feasible cost-effective interventions for the prevention and treatment of NCDs will achieve the 25 by 25 goal and will need only few additional financial resources. Accountability incorporates three dimensions: monitoring of progress, reviewing of progress, and appropriate responses to accelerate progress. A national NCD commission or equivalent, which is independent of government, is needed to ensure that all relevant stakeholders are held accountable for the UN commitments to NCDs. Copyright © 2013 Elsevier Ltd. All rights reserved.

Can the sustainable development goals reduce the burden of nutrition-related non-communicable diseases without truly addressing major food system reforms?

PubMed

Hawkes, Corinna; Popkin, Barry M

2015-06-16

While the Millennium Development Goals (MDGs; 2000-2015) focused primarily on poverty reduction, hunger and infectious diseases, the proposed Sustainable Development Goals (SDGs) and targets pay more attention to nutrition and non-communicable diseases (NCDs). One of the 169 proposed targets of the SDGs is to reduce premature deaths from NCDs by one third; another is to end malnutrition in all its forms. Nutrition-related NCDs (NR-NCDs) stand at the intersection between malnutrition and NCDs. Driven in large part by remarkable transformations of food systems, they are rapidly increasing in most low and middle income countries (LMICs). The transformation to modern food systems began in the period following World War II with policies designed to meet a very different set of nutritional and food needs, and continued with globalization in the 1990s onwards. Another type of food systems transformation will be needed to shift towards a healthier and more sustainable diet--as will meeting many of the other SDGs. The process will be complex but is necessary. Communities concerned with NCDs and with malnutrition need to work more closely together to demand food systems change.

Non-communicable diseases in decontamination workers in areas affected by the Fukushima nuclear disaster: a retrospective observational study.

PubMed

Sawano, Toyoaki; Tsubokura, Masaharu; Ozaki, Akihiko; Leppold, Claire; Nomura, Shuhei; Shimada, Yuki; Ochi, Sae; Tsukada, Manabu; Nemoto, Tsuyoshi; Kato, Shigeaki; Kanazawa, Yukio; Ohira, Hiromichi

2016-12-14

To assess the prevalence of non-communicable diseases (NCDs), and whether NCDs were treated or not, among hospitalised decontamination workers who moved to radio-contaminated areas after Japan's 2011 Fukushima Daiichi Nuclear Power Plant disaster. We retrospectively extracted records of decontamination workers admitted to Minamisoma Municipal General Hospital between 1 June 2012 and 31 August 2015, from hospital records. We investigated the incidence of underlying NCDs such as hypertension, dyslipidaemia and diabetes among the decontamination workers, and their treatment status, in addition to the reasons for their hospital admission. A total of 113 decontamination workers were admitted to the hospital (112 male patients, median age of 54 years (age range: 18-69 years)). In terms of the demographics of underlying NCDs in this population, 57 of 72 hypertensive patients (79.2%), 37 of 45 dyslipidaemic patients (82.2%) and 18 of 27 hyperglycaemic patients (66.7%) had not been treated for their NCDs before admission to the hospital. A high burden of underlying NCDs was found in hospitalised decontamination workers in Fukushima. Managing underlying diseases such as hypertension, hyperlipidaemia and diabetes mellitus is essential among this population. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Burden and correlates of non-communicable-diseases among rural residents: a cross-sectional study in Hebei, China.

PubMed

Yang, Junjun; Yu, Wenya; Zhou, Qiang; Mahapatra, Tanmay; Li, Yiqiu; Zhang, Xiaoyan; Chen, Lei; Mahapatra, Sanchita; Yan, Yuying; Tang, Weiming

2015-06-20

Burden of non-communicable diseases (NCDs) is increasing rapidly in most of the developing countries including China, even in rural areas. Dearth of representative data called for an investigation to estimate the burden and identify the correlates of NCDs in rural China. A cross-sectional study was conducted involving a representative sample of 6003 consenting randomly selected rural residents aged 15 years or more, from 36 villages of Shijiazhuang in Hebei province of China between July 2010 and June 2011. Information on demographics and behavior were collected, body mass index (BMI) and blood pressure were measured and blood samples were tested to diagnose diabetes and hyperlipidemia. Majority participants were aged < 30 year, married and educated up to junior/senior high school level. Mean age for the 6003 participants was 37.4 ± 14.8. About 55.7% had BMI of 18.6-24.9. In past 12 months: 19.8% smoked daily, 41.6% were exposed to passive smoking, 28.5% drank alcohol, 10.4% skipped breakfasts frequently, 82.8% did never exercise and 25.3% had psychological disturbances. 51.1% were hypertensive, 6.7% were diabetic and 9.2% had hyperlipidemia. Based on self-reports, cardiovascular diseases (4.5%), cerebrovascular diseases (2.3%), cancers (0.2%), chronic obstructive pulmonary diseases (2%), orthopedic problems (12.1%) and gastrointestinal NCDs (7.8%) were identified among the participants, while proportion of subjects with one, two and three or more NCDs were 43%, 14.4% and 5.5% respectively. Higher odds of having more NCDs were associated with higher BMI (Kg/M(2)), family history of NCDs, daily and past history of smoking and drinking, passive smoking, lack of exercise, skipping breakfast and psychological disturbances. Despite limitations associated with cross-sectional design and self-reporting, observation in this large sample of rural residents could develop important insights regarding high burden of NCDs in this population. Based on the identified

The financial burden from non-communicable diseases in low- and middle-income countries: a literature review

PubMed Central

2013-01-01

Non-communicable diseases (NCDs) were previously considered to only affect high-income countries. However, they now account for a very large burden in terms of both mortality and morbidity in low- and middle-income countries (LMICs), although little is known about the impact these diseases have on households in these countries. In this paper, we present a literature review on the costs imposed by NCDs on households in LMICs. We examine both the costs of obtaining medical care and the costs associated with being unable to work, while discussing the methodological issues of particular studies. The results suggest that NCDs pose a heavy financial burden on many affected households; poor households are the most financially affected when they seek care. Medicines are usually the largest component of costs and the use of originator brand medicines leads to higher than necessary expenses. In particular, in the treatment of diabetes, insulin – when required – represents an important source of spending for patients and their families. These financial costs deter many people suffering from NCDs from seeking the care they need. The limited health insurance coverage for NCDs is reflected in the low proportions of patients claiming reimbursement and the low reimbursement rates in existing insurance schemes. The costs associated with lost income-earning opportunities are also significant for many households. Therefore, NCDs impose a substantial financial burden on many households, including the poor in low-income countries. The financial costs of obtaining care also impose insurmountable barriers to access for some people, which illustrates the urgency of improving financial risk protection in health in LMIC settings and ensuring that NCDs are taken into account in these systems. In this paper, we identify areas where further research is needed to have a better view of the costs incurred by households because of NCDs; namely, the extension of the geographical scope, the

The financial burden from non-communicable diseases in low- and middle-income countries: a literature review.

PubMed

Kankeu, Hyacinthe Tchewonpi; Saksena, Priyanka; Xu, Ke; Evans, David B

2013-08-16

Non-communicable diseases (NCDs) were previously considered to only affect high-income countries. However, they now account for a very large burden in terms of both mortality and morbidity in low- and middle-income countries (LMICs), although little is known about the impact these diseases have on households in these countries. In this paper, we present a literature review on the costs imposed by NCDs on households in LMICs. We examine both the costs of obtaining medical care and the costs associated with being unable to work, while discussing the methodological issues of particular studies. The results suggest that NCDs pose a heavy financial burden on many affected households; poor households are the most financially affected when they seek care. Medicines are usually the largest component of costs and the use of originator brand medicines leads to higher than necessary expenses. In particular, in the treatment of diabetes, insulin--when required--represents an important source of spending for patients and their families. These financial costs deter many people suffering from NCDs from seeking the care they need. The limited health insurance coverage for NCDs is reflected in the low proportions of patients claiming reimbursement and the low reimbursement rates in existing insurance schemes. The costs associated with lost income-earning opportunities are also significant for many households. Therefore, NCDs impose a substantial financial burden on many households, including the poor in low-income countries. The financial costs of obtaining care also impose insurmountable barriers to access for some people, which illustrates the urgency of improving financial risk protection in health in LMIC settings and ensuring that NCDs are taken into account in these systems. In this paper, we identify areas where further research is needed to have a better view of the costs incurred by households because of NCDs; namely, the extension of the geographical scope, the inclusion

Addressing non-communicable diseases in Malaysia: an integrative process of systems and community

PubMed Central

2014-01-01

The prevalence of non-communicable diseases (NCDs) and NCD risk factors in Malaysia have risen substantially in the last two decades. The Malaysian Ministry of Health responded by implementing, “The National Strategic Plan for Non-Communicable Diseases (NSP-NCD) 2010-2014”, and the “NCD Prevention 1Malaysia” (NCDP-1M) programme. This paper outlines the primary health system context in which the NCDP-1M is framed. We also discuss the role of community in facilitating the integration of this programme, and outline some of the key challenges in addressing the sustainability of the plan over the next few years. The paper thus provides an analysis of an integration of a programme that involved a multi-sectoral approach with the view to contributing to a broader discourse on the development of responsive health systems. PMID:25080846

Distribution and Determinants of Non Communicable Diseases among Elderly Uyghur Ethnic Group in Xinjiang, China

PubMed Central

Wang, Xihua; Hu, Zhi; Ma, Ying; Tang, Weiming; Ben, Yanli; Mahapatra, Tanmay; Cao, Xiaolin; Mahapatra, Sanchita; Ling, Min; Gou, Anshuan; Wang, Yanmei; Xiao, Jiangqin; Hou, Ming; Wang, Xiuli; Lin, Bo; Wang, Faxing

2014-01-01

Background Non-communicable diseases (NCDs) are showing an increasing trend globally as well as in China. Elderly population are more prone to these NCDs. Situation in China is worse owing to the higher proportion of geriatric population. Burden of NCDs and the role of their socio-demographic and behavioral predictors among these elderly and more so among the ethnic minority groups among them, need to be investigated specifically, owing to their distinct genetic background, lifestyles and behavior. Methods A cross-sectional study was conducted among 1329 randomly selected persons of Uyghur ethnicity, aged 60 years or more in Xinjiang, the largest administrative division in China to measure the burden of NCDs, understand the distribution of socio-demographic, behavioral and life event-related potential correlates of them and to estimate the association of the NCDs with these correlates. Results Among these participants 54.2% were female, 86.8% were married and more than half had only attended elementary school or less. 41.46% was suffering from at least one NCD. 20.22% had one NCD, 12.11% had two and 8.58% had three or more. 27.3% had hypertension, 4.06% had diabetes, 6.02% had hyperlipidemia, 7.37% had angina, 14.52% had cardiovascular diseases, 11.59% had any kind of cancers and 9.78% had chronic obstructive pulmonary diseases. Rural residents (OR = 1.45, 95% CI: 1.17–1.80, AOR = 2.00, 95% CI: 1.53–2.61) and current smokers had higher odds of having more NCDs (AOR = 1.53, 95% CI: 1.00–2.34). Additionally not being satisfied with current life, not being able to take care of self in daily life, currently not being involved in farm work, less intake of fresh vegetables, fruits and garlic, too less or too much salt intake, not having hobbies were found to be positively associated with having more NCDs. Conclusion Implementation of effective intervention strategies to promote healthy life styles among the Uyghur elderly population of China seems

Bangladesh policy on prevention and control of non-communicable diseases: a policy analysis.

PubMed

Biswas, Tuhin; Pervin, Sonia; Tanim, Md Imtiaz Alam; Niessen, Louis; Islam, Anwar

2017-06-19

This paper is aimed at critically assessing the extent to which Non-Communicable Disease NCD-related policies introduced in Bangladesh align with the World Health Organization's (WHO) 2013-2020 Action Plan for the Global Strategy for the Prevention and Control of NCDs. The authors reviewed all relevant policy documents introduced by the Government of Bangladesh since its independence in 1971. The literature review targeted scientific and grey literature documents involving internet-based search, and expert consultation and snowballing to identify relevant policy documents. Information was extracted from the documents using a specific matrix, mapping each document against the six objectives of the WHO 2013-2020 Action Plan for the Global Strategy for the Prevention and Control of NCDs. A total of 51 documents were identified. Seven (14%) were research and/or surveys, nine were on established policies (17%), while seventeen (33%) were on action programmes. Five (10%) were related to guidelines and thirteen (25%) were strategic planning documents from government and non-government agencies/institutes. The study covered documents produced by the Government of Bangladesh as well as those by quasi-government and non-government organizations irrespective of the extent to which the intended policies were implemented. The policy analysis findings suggest that although the government has initiated many NCD-related policies or programs, they lacked proper planning, implementation and monitoring. Consequently, Bangladesh over the years had little success in effectively addressing the growing burden of non-communicable diseases. It is imperative that future research critically assess the effectiveness of national NCD policies by monitoring their implementation and level of population coverage.

The Transferability of Health Promotion and Education Approaches Between Non-communicable Diseases and Communicable Diseases—an Analysis of Evidence

PubMed Central

McQueen, David V.; Manoncourt, Erma; Cartier, Yuri N.; Dinca, Irina; Nurm, Ülla-Karin

2014-01-01

Background There is a seeming lack within the public health fields of both research and practice of information sharing across so-called “silos of work”. Many professionals in the public health fields dealing with infectious diseases (IDs) are unaware of the programs and approaches taken by their colleagues in the non-communicable diseases (NCDs) arena, and vice versa. A particular instance of this is in the understanding and application of health promotion approaches. This is a problem that needs to be addressed with the goal of producing the most efficient and effective health promotion approaches to the prevention and control of diseases in general. Objectives This project examined health promotion approaches to the prevention of NCDs that could be used in the prevention of IDs. Methods A knowledge synthesis and translation perspective was undertaken. We screened and analyzed a wide range of sources that were considered relevant, with particular emphasis on systematic reviews, published articles and the grey literature. Results The analysis revealed a diverse health promotion knowledge base for application to IDs. Comprehensive health promotion models were found to be useful. Findings suggest that there are profound similarities for health promotion approaches in both NCDs and IDs. Conclusions: This study revealed gaps in knowledge synthesis to translation. The need for development of intervention and implementation research is considered. PMID:29546085

Who is bearing the financial burden of non-communicable diseases in Mongolia?

PubMed Central

Dugee, Otgontuya; Palam, Enkhtuya; Dorjsuren, Bayarsaikhan; Mahal, Ajay

2018-01-01

Background Non-communicable diseases (NCDs) pose a formidable health and development challenge for low- and middle-income countries (LMICs). However, translating this challenge into resource allocation is seriously constrained by a lack of country specific evidence on NCD financing and its distributional implications. This study estimated expenditures associated with NCDs in Mongolia and their distributions across socioeconomic groups, focusing especially on private out-of-pocket (OOP) spending on the major NCDs. Methods Secondary data analysis of multiple data sources on NCD related health service use and expenditures including detailed administrative data, World Health Organization STEPwise approach to Surveillance (STEPs) survey for Mongolia, and household surveys. Sample-weighted estimates of OOP expenditures for NCDs were constructed using STEPs data. OOP payments per discharge and per outpatient visit were estimated by condition and type of service provider, and survey data on utilization, after adjusting for utilization in administrative records. Results NCDs in Mongolia accounted for more than one-third of total health expenditures in 2013. A significant fraction of this expenditure was borne by households in the form of OOP spending. CVD-related health spending is the major driver of NCD-spending in Mongolia, accounting for about 24.2% of total health expenditure. OOP health payments, largely driven by outpatient diagnostics and drugs, were incurred disproportionately by the better-off, seeking more specialist services and better quality private care. Conclusion A high share of OOP spending for NCDs in Mongolia, which ostensibly enjoys universal health coverage, provides a cautionary tale for LMICs in a similar situation. Improvement in the quality of services at the primary care level and rural health care facilities, where the poor mainly attend, is desirable together with an effective exemption policy for user fees at higher level hospitals. PMID

Horizontal inequity in public health care service utilization for non-communicable diseases in urban Vietnam

PubMed Central

Kien, Vu Duy; Van Minh, Hoang; Giang, Kim Bao; Weinehall, Lars; Ng, Nawi

2014-01-01

Background A health system that provides equitable health care is a principal goal in many countries. Measuring horizontal inequity (HI) in health care utilization is important to develop appropriate and equitable public policies, especially policies related to non-communicable diseases (NCDs). Design A cross-sectional survey of 1,211 randomly selected households in slum and non-slum areas was carried out in four urban districts of Hanoi city in 2013. This study utilized data from 3,736 individuals aged 15 years and older. Respondents were asked about health care use during the previous 12 months; information included sex, age, and self-reported NCDs. We assessed the extent of inequity in utilization of public health care services. Concentration indexes for health care utilization and health care needs were constructed via probit regression of individual utilization of public health care services, controlling for age, sex, and NCDs. In addition, concentration indexes were decomposed to identify factors contributing to inequalities in health care utilization. Results The proportion of healthcare utilization in the slum and non-slum areas was 21.4 and 26.9%, respectively. HI in health care utilization in favor of the rich was observed in the slum areas, whereas horizontal equity was achieved among the non-slum areas. In the slum areas, we identified some key factors that affect the utilization of public health care services. Conclusion Our results suggest that to achieve horizontal equity in utilization of public health care services, policy should target preventive interventions for NCDs, focusing more on the poor in slum areas. PMID:25095780

Potential use of telephone-based survey for non-communicable disease surveillance in Sri Lanka.

PubMed

Herath, H M M; Weerasinghe, N P; Weerarathna, T P; Hemantha, A; Amarathunga, A

2017-12-29

Telephone survey (TS) has been a popular tool for conducting health surveys, particularly in developed countries. However, the feasibility, and reliability of TS are not adequately explored in Sri Lanka. The main aim of this study is to assess the effectiveness of telephone-based survey in estimating the prevalence of common non-communicable diseases (NCDs) in Sri Lanka. We carried out an observational cross-sectional study using telephone interview method in Galle district, Sri Lanka. The study participants were selected randomly from the residents living in the households with fixed land telephone lines. The prevalence of the main NCDs was estimated using descriptive statistics. Overall, 975 telephone numbers belonging to six main areas of Galle district were called, and 48% agreed to participate in the study. Of the non-respondents, 22% actively declined to participate. Data on NCDs were gathered from 1470 individuals. The most common self-reported NCD was hypertension (17.%), followed by diabetes (16.3%) and dyslipidaemia (15.6%). Smoking was exclusively seen in males (7.4%), and regular alcohol use was significantly more common in males (19.2%) than females (0.4%, P < .001). Our study revealed average response rate for telephone based interview in Sri Lankan setting. Overall prevalence of main NCDs in this study showed a comparable prevalence to studies used face to face interview method. This study supports the potential use of telephone-based survey to assess heath related information in Sri Lanka.

Medicalization of global health 3: the medicalization of the non-communicable diseases agenda

PubMed Central

Clark, Jocalyn

2014-01-01

There is growing recognition of the massive global burden of non-communicable diseases (NCDs) due to their prevalence, projected social and economic costs, and traditional neglect compared to infectious disease. The 2011 UN Summit, WHO 25×25 targets, and support of major medical and advocacy organisations have propelled prominence of NCDs on the global health agenda. NCDs are by definition ‘diseases’ so already medicalized. But their social drivers and impacts are acknowledged, which demand a broad, whole-of-society approach. However, while both individual- and population-level targets are identified in the current NCD action plans, most recommended strategies tend towards the individualistic approach and do not address root causes of the NCD problem. These so-called population strategies risk being reduced to expectations of individual and behavioural change, which may have limited success and impact and deflect attention away from government policies or regulation of industry. Industry involvement in NCD agenda-setting props up a medicalized approach to NCDs: food and drink companies favour focus on individual choice and responsibility, and pharmaceutical and device companies favour calls for expanded access to medicines and treatment coverage. Current NCD framing creates expanded roles for physicians, healthcare workers, medicines and medical monitoring. The professional rather than the patient view dominates the NCD agenda and there is a lack of a broad, engaged, and independent NGO community. The challenge and opportunity lie in defining priorities and developing strategies that go beyond a narrow medicalized framing of the NCD problem and its solutions. PMID:24848661

Socio-Economic Inequality of Chronic Non-Communicable Diseases in Bangladesh.

PubMed

Biswas, Tuhin; Islam, Md Saimul; Linton, Natalie; Rawal, Lal B

2016-01-01

Chronic non-communicable diseases (NCDs) are a major public health challenge, and undermine social and economic development in much of the developing world, including Bangladesh. Epidemiologic evidence on the socioeconomic status (SES)-related pattern of NCDs remains limited in Bangladesh. This study assessed the relationship between three chronic NCDs and SES among the Bangladeshi population, paying particular attention to the differences between urban and rural areas. Data from the 2011 Bangladesh Demographic and Health Survey were used for this study. Using a concentration index (CI), we measured relative inequality across pre-diabetes, diabetes, pre-hypertension, hypertension, and BMI (underweight, normal weight, and overweight/obese) in urban and rural areas in Bangladesh. A CI and its associated curve can be used to identify whether socioeconomic inequality exists for a given health variable. In addition, we estimated the health achievement index, integrating mean coverage and the distribution of coverage by rural and urban populations. Socioeconomic inequalities were observed across diseases and risk factors. Using CI, significant inequalities observed for pre-hypertension (CI = 0.09, p = 0.001), hypertension (CI = 0.10, p = 0.001), pre-diabetes (CI = -0.01, p = 0.005), diabetes (CI = 0.19, p<0.001), and overweight/obesity (CI = 0.45, p<0.001). In contrast to the high prevalence of the chronic health conditions among the urban richest, a significant difference in CI was observed for pre-hypertension (CI = -0.20, p = 0.001), hypertension (CI = -0.20, p = 0.005), pre-diabetes (CI = -0.15, p = 0.005), diabetes (CI = -0.26, p = 0.004) and overweight/obesity (CI = 0.25, p = 0.004) were observed more among the low wealth quintiles of rural population. In the same vein, the poorest rural households had more co-morbidities compared to the richest rural households (p = 0.003), and prevalence of co-morbidities was much higher for the richest urban households compared

Promotion of access to essential medicines for non-communicable diseases: practical implications of the UN political declaration.

PubMed

Hogerzeil, Hans V; Liberman, Jonathan; Wirtz, Veronika J; Kishore, Sandeep P; Selvaraj, Sakthi; Kiddell-Monroe, Rachel; Mwangi-Powell, Faith N; von Schoen-Angerer, Tido

2013-02-23

Access to medicines and vaccines to prevent and treat non-communicable diseases (NCDs) is unacceptably low worldwide. In the 2011 UN political declaration on the prevention and control of NCDs, heads of government made several commitments related to access to essential medicines, technologies, and vaccines for such diseases. 30 years of experience with policies for essential medicines and 10 years of scaling up of HIV treatment have provided the knowledge needed to address barriers to long-term effective treatment and prevention of NCDs. More medicines can be acquired within existing budgets with efficient selection, procurement, and use of generic medicines. Furthermore, low-income and middle-income countries need to increase mobilisation of domestic resources to cater for the many patients with NCDs who do not have access to treatment. Existing initiatives for HIV treatment offer useful lessons that can enhance access to pharmaceutical management of NCDs and improve adherence to long-term treatment of chronic illness; policy makers should also address unacceptable inequities in access to controlled opioid analgesics. In addition to off-patent medicines, governments can promote access to new and future on-patent medicinal products through coherent and equitable health and trade policies, particularly those for intellectual property. Frequent conflicts of interest need to be identified and managed, and indicators and targets for access to NCD medicines should be used to monitor progress. Only with these approaches can a difference be made to the lives of hundreds of millions of current and future patients with NCDs. Copyright © 2013 Elsevier Ltd. All rights reserved.

Basic Risk Factors Awareness in Non-Communicable Diseases (BRAND) Study Among People Visiting Tertiary Care Centre in Mysuru, Karnataka.

PubMed

Thippeswamy, Thippeswamy; Chikkegowda, Prathima

2016-04-01

Non Communicable Diseases (NCDs) are the major causes of mortality and morbidity globally. Awareness about NCDs and their risk factors has an important role in prevention and management strategies of these NCDs. 1) To assess the awareness of risk factors contributing to NCDs among the patients visiting tertiary care hospital in Mysuru district; 2) To compare the difference in awareness of risk factors for NCDs among the urban and rural patients with/ without NCD visiting the tertiary care hospital. A cross- sectional study was conducted in a tertiary care centre- JSS Hospital, Mysuru, Karnataka from March 2013 - August 2013. The patients visiting Medicine OPD during the period were the study subjects. The subjects were allocated into 4 groups: Urban without any NCD, Urban with atleast one NCD, rural without NCD, rural with atleast one NCD. A pretested questionnaire regarding awareness of risk factors for NCDs was used in the study and frequency and proportions were used to analyse the data. A total of 400 subjects, 100 subjects in each group were included in the study. Out of these subjects about 65% of the urban group and 42% of the rural group subjects were aware of the NCDs and their risk factors. Least awareness was observed among the rural subjects without any NCDs (35%). The awareness of risk factors of NCDs and knowledge regarding prevention of NCDs was not satisfactory. The results highlighted the need and scope for health education and interventions to improve the awareness about NCDs and their risk factors.

CD4/CD8 ratio, age, and risk of serious non-communicable diseases in HIV-infected adults on antiretroviral therapy

PubMed Central

CASTILHO, Jessica L.; SHEPHERD, Bryan E.; KOETHE, John; TURNER, Megan; BEBAWY, Sally; LOGAN, James; ROGERS, William B.; RAFFANTI, Stephen; STERLING, Timothy R.

2015-01-01

Objective In virologically suppressed HIV-infected adults, non-communicable diseases (NCDs) have been associated with immune senescence and low CD4/CD8 lymphocyte ratio. Age differences in the relationship between CD4/CD8 ratio and NCDs have not been described. Design Observational cohort study. Methods We assessed CD4/CD8 ratio and incident NCDs (cardiovascular, cancer, liver, and renal diseases) in HIV-infected adults started on antiretroviral therapy between 1998–2012. Study inclusion began once patients maintained virologic suppression for 12 months (defined as baseline). We examined age and baseline CD4/CD8 ratio and used Cox proportional hazard models to assess baseline CD4/CD8 ratio and NCDs. Results This study included 2,006 patients. Low baseline CD4/CD8 ratio was associated with older age, male sex, and low CD4 lymphocyte counts. In models adjusting for CD4 lymphocyte count, CD4/CD8 ratio was inversely associated with age (p <0.01). Among all patients, 182 had incident NCDs, including 46 with coronary artery disease (CAD) events. CD4/CD8 ratio was inversely associated with risk of CAD events (adjusted HR per 0.1 increase in CD4/CD8 ratio = 0.87, 95% CI: 0.76–0.99, p=0.03). This association was driven by those under age 50 years (adjusted HR 0.83 [0.70–0.97], p = 0.02) versus those over age 50 years (adjusted HR = 0.96 [0.79–1.18], p = 0.71). CD4/CD8 ratio was not significantly associated with incident non-cardiac NCDs. Conclusions Higher CD4/CD8 ratio after one year of HIV virologic suppression was independently predictive of decreased CAD risk, particularly among younger adults. Advanced immune senescence may contribute to CAD events in younger HIV patients on antiretroviral therapy. PMID:26959354

INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support): overview and key principles.

PubMed

Swinburn, B; Sacks, G; Vandevijvere, S; Kumanyika, S; Lobstein, T; Neal, B; Barquera, S; Friel, S; Hawkes, C; Kelly, B; L'abbé, M; Lee, A; Ma, J; Macmullan, J; Mohan, S; Monteiro, C; Rayner, M; Sanders, D; Snowdon, W; Walker, C

2013-10-01

Non-communicable diseases (NCDs) dominate disease burdens globally and poor nutrition increasingly contributes to this global burden. Comprehensive monitoring of food environments, and evaluation of the impact of public and private sector policies on food environments is needed to strengthen accountability systems to reduce NCDs. The International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) is a global network of public-interest organizations and researchers that aims to monitor, benchmark and support public and private sector actions to create healthy food environments and reduce obesity, NCDs and their related inequalities. The INFORMAS framework includes two 'process' modules, that monitor the policies and actions of the public and private sectors, seven 'impact' modules that monitor the key characteristics of food environments and three 'outcome' modules that monitor dietary quality, risk factors and NCD morbidity and mortality. Monitoring frameworks and indicators have been developed for 10 modules to provide consistency, but allowing for stepwise approaches ('minimal', 'expanded', 'optimal') to data collection and analysis. INFORMAS data will enable benchmarking of food environments between countries, and monitoring of progress over time within countries. Through monitoring and benchmarking, INFORMAS will strengthen the accountability systems needed to help reduce the burden of obesity, NCDs and their related inequalities. © 2013 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of the International Association for the Study of Obesity.

The global impact of non-communicable diseases on households and impoverishment: a systematic review.

PubMed

Jaspers, Loes; Colpani, Veronica; Chaker, Layal; van der Lee, Sven J; Muka, Taulant; Imo, David; Mendis, Shanthi; Chowdhury, Rajiv; Bramer, Wichor M; Falla, Abby; Pazoki, Raha; Franco, Oscar H

2015-03-01

The global economic impact of non-communicable diseases (NCDs) on household expenditures and poverty indicators remains less well understood. To conduct a systematic review and meta-analysis of the literature evaluating the global economic impact of six NCDs [including coronary heart disease, stroke, type 2 diabetes mellitus (DM), cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD)] on households and impoverishment. Medline, Embase and Google Scholar databases were searched from inception to November 6th 2014. To identify additional publications, reference lists of retrieved studies were searched. Randomized controlled trials, systematic reviews, cohorts, case-control, cross-sectional, modeling and ecological studies carried out in adults and assessing the economic consequences of NCDs on households and impoverishment. No language restrictions. All abstract and full text selection was done by two independent reviewers. Data were extracted by two independent reviewers and checked by a third independent reviewer. Studies were included evaluating the impact of at least one of the selected NCDs and on at least one of the following measures: expenditure on medication, transport, co-morbidities, out-of-pocket (OOP) payments or other indirect costs; impoverishment, poverty line and catastrophic spending; household or individual financial cost. From 3,241 references, 64 studies met the inclusion criteria, 75% of which originated from the Americas and Western Pacific WHO region. Breast cancer and DM were the most studied NCDs (42 in total); CKD and COPD were the least represented (five and three studies respectively). OOP payments and financial catastrophe, mostly defined as OOP exceeding a certain proportion of household income, were the most studied outcomes. OOP expenditure as a proportion of family income, ranged between 2 and 158% across the different NCDs and countries. Financial catastrophe due to

Patent and Exclusivity Status of Essential Medicines for Non-Communicable Disease

PubMed Central

Mackey, Tim K.; Liang, Bryan A.

2012-01-01

Objective The threat of non-communicable diseases (“NCDs”) is increasingly becoming a global health crisis and are pervasive in high, middle, and low-income populations resulting in an estimated 36 million deaths per year. There is a need to assess intellectual property rights (“IPRs”) that may impede generic production and availability and affordability to essential NCD medicines. Methods Using the data sources listed below, the study design systematically eliminated NCD drugs that had no patent/exclusivity provisions on API, dosage, or administration route. The first step identified essential medicines that treat certain high disease burden NCDs. A second step examined the patent and exclusivity status of active ingredient, dosage and listed route of administration using exclusion criteria outlined in this study. Materials We examined the patent and exclusivity status of medicines listed in the World Health Organization’s (“WHO”) Model List of Essential Drugs (Medicines) (“MLEM”) and other WHO sources for drugs treating certain NCDs. i.e., cardiovascular and respiratory disease, cancers, and diabetes. We utilized the USA Food and Drug Administration Orange Book and the USA Patent and Trademark Office databases as references given the predominant number of medicines registered in the USA. Results Of the 359 MLEM medicines identified, 22% (79/359) address targeted NCDs. Of these 79, only eight required in-depth patent or exclusivity assessment. Upon further review, no NCD MLEM medicines had study patent or exclusivity protection for reviewed criteria. Conclusions We find that ensuring availability and affordability of potential generic formulations of NCD MLEM medicines appears to be more complex than the presence of IPRs with API, dosage, or administration patent or exclusivity protection. Hence, more sophisticated analysis of NCD barriers to generic availability and affordability should be conducted in order to ensure equitable access to global

Investing in non-communicable diseases: an estimation of the return on investment for prevention and treatment services.

PubMed

Bertram, Melanie Y; Sweeny, Kim; Lauer, Jeremy A; Chisholm, Daniel; Sheehan, Peter; Rasmussen, Bruce; Upreti, Senendra Raj; Dixit, Lonim Prasai; George, Kenneth; Deane, Samuel

2018-05-19

The global burden of non-communicable diseases (NCDs) is growing, and there is an urgent need to estimate the costs and benefits of an investment strategy to prevent and control NCDs. Results from an investment-case analysis can provide important new evidence to inform decision making by governments and donors. We propose a methodology for calculating the economic benefits of investing in NCDs during the Sustainable Development Goals (SDGs) era, and we applied this methodology to cardiovascular disease prevention in 20 countries with the highest NCD burden. For a limited set of prevention interventions, we estimated that US$120 billion must be invested in these countries between 2015 and 2030. This investment represents an additional $1·50 per capita per year and would avert 15 million deaths, 8 million incidents of ischaemic heart disease, and 13 million incidents of stroke in the 20 countries. Benefit-cost ratios varied between interventions and country-income levels, with an average ratio of 5·6 for economic returns but a ratio of 10·9 if social returns are included. Investing in cardiovascular disease prevention is integral to achieving SDG target 3.4 (reducing premature mortality from NCDs by a third) and to progress towards SDG target 3.8 (the realisation of universal health coverage). Many countries have implemented cost-effective interventions at low levels, so the potential to achieve these targets and strengthen national income by scaling up these interventions is enormous. Copyright © 2018 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Published by Elsevier Ltd.. All rights reserved.

Socio-Economic Inequality of Chronic Non-Communicable Diseases in Bangladesh

PubMed Central

Biswas, Tuhin; Islam, Md. Saimul; Linton, Natalie; Rawal, Lal B.

2016-01-01

Introduction Chronic non-communicable diseases (NCDs) are a major public health challenge, and undermine social and economic development in much of the developing world, including Bangladesh. Epidemiologic evidence on the socioeconomic status (SES)-related pattern of NCDs remains limited in Bangladesh. This study assessed the relationship between three chronic NCDs and SES among the Bangladeshi population, paying particular attention to the differences between urban and rural areas. Materials and Method Data from the 2011 Bangladesh Demographic and Health Survey were used for this study. Using a concentration index (CI), we measured relative inequality across pre-diabetes, diabetes, pre-hypertension, hypertension, and BMI (underweight, normal weight, and overweight/obese) in urban and rural areas in Bangladesh. A CI and its associated curve can be used to identify whether socioeconomic inequality exists for a given health variable. In addition, we estimated the health achievement index, integrating mean coverage and the distribution of coverage by rural and urban populations. Results Socioeconomic inequalities were observed across diseases and risk factors. Using CI, significant inequalities observed for pre-hypertension (CI = 0.09, p = 0.001), hypertension (CI = 0.10, p = 0.001), pre-diabetes (CI = -0.01, p = 0.005), diabetes (CI = 0.19, p<0.001), and overweight/obesity (CI = 0.45, p<0.001). In contrast to the high prevalence of the chronic health conditions among the urban richest, a significant difference in CI was observed for pre-hypertension (CI = -0.20, p = 0.001), hypertension (CI = -0.20, p = 0.005), pre-diabetes (CI = -0.15, p = 0.005), diabetes (CI = -0.26, p = 0.004) and overweight/obesity (CI = 0.25, p = 0.004) were observed more among the low wealth quintiles of rural population. In the same vein, the poorest rural households had more co-morbidities compared to the richest rural households (p = 0.003), and prevalence of co-morbidities was much higher

Prevention and control of major non-communicable diseases in China from 1990 to 2009: results of a two-round Delphi survey.

PubMed

Lv, Jun; Liu, Miao; Jiang, Yu; Li, Li-Ming

2013-02-12

The aim of this study was to learn about the progress of the prevention and control of major non-communicable diseases (NCDs) in China from 1990 to 2009 and to determine what prevention and control gaps remain based on the opinions of a group of panellists. Sixty-four panellists, who are members of the Subcommittee of the Non-Communicable Diseases, the Expert Committee on Disease Control and Prevention established by China's Ministry of Health in 2010, were invited to participate in an email-based, two-round Delphi survey. In each round, a structured questionnaire was given to participants, who were asked to rate the importance and practical implementation of items relevant to the prevention and control of NCDs over two periods, 1990-1999 and 2000-2009, on a 10-point scale. Of the 64 panellists invited, 20 (31.3%) completed the first-round survey, and, of those, 14 (70.0%) completed the second-round survey. Of the 237 common variables in the two survey rounds, there were 161 (67.9%) and 209 (88.2%) with an interquartile range ≤2 in the first round and second round, respectively. These results indicated a better expert consensus in the second round. There were 92 items in total in the second round of the questionnaire, 88 (95.7%) of which had median importance rating scores of equal to or greater than 7.00. The median scores for the practical implementation items during 2000-2009 were greater than those for the 1990-1999 period. The results indicate improved implementation in the recent decade. China has made progress in the prevention and control of NCDs during the 21st century. However, these intuitive rating results indicate that there are still large action gaps in the fight against epidemic NCDs in China.

Non-communicable diseases at a regional hospital in Nepal: Findings of a high burden of alcohol-related disease.

PubMed

Amundsen, M S; Kirkeby, T M G; Giri, S; Koju, R; Krishna, S S; Ystgaard, B; Solligård, E; Risnes, K

2016-12-01

Recent global burden of disease reports find that a major proportion of global deaths and disability worldwide can be attributed to alcohol use. Thus, it may be surprising that very few studies have reported on the burden of alcohol-related disease in low income settings. The evidence of non-communicable disease (NCD) burden in Nepal was recently reviewed and concluded that data is still lacking, particularly to describe the burden of alcohol-related diseases (ARDs). Therefore, here we report on NCD burden and specifically ARDs, in hospitalized patients at a regional hospital in Nepal. We conducted a retrospective chart-review that included detailed information on all discharged patients during a four month period. A local database that included sociodemographic information and diagnoses at discharge was established. All doctor-assigned discharge diagnoses were retrospectively assigned ICD-10 codes. A total of 1,139 hospitalized adult patients were included in the study and one third of these were NCDs (n = 332). The main NCDs were chronic obstructive pulmonary disease (COPD) (n = 148, 45%) and ARDs (n = 57, 17%). Patients with ARD often presented with signs of liver cirrhosis and were typically younger men, with a median age at 43 years, from specific ethnic groups. These data demonstrate that severe alcohol-related organ failure in relatively young men contributed to a high proportion of NCDs in a regional hospital in Nepal. These findings are novel and alarming and warrant further studies that can establish the burden of ARDs and alcohol use in Nepal and other similar low-income countries. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

The role of law and governance reform in the global response to non-communicable diseases.

PubMed

Magnusson, Roger S; Patterson, David

2014-06-05

Addressing non-communicable diseases ("NCDs") and their risk-factors is one of the most powerful ways of improving longevity and healthy life expectancy for the foreseeable future - especially in low- and middle-income countries. This paper reviews the role of law and governance reform in that process. We highlight the need for a comprehensive approach that is grounded in the right to health and addresses three aspects: preventing NCDs and their risk factors, improving access to NCD treatments, and addressing the social impacts of illness. We highlight some of the major impediments to the passage and implementation of laws for the prevention and control of NCDs, and identify important practical steps that governments can take as they consider legal and governance reforms at country level.We review the emerging global architecture for NCDs, and emphasise the need for governance structures to harness the energy of civil society organisations and to create a global movement that influences the policy agenda at the country level. We also argue that the global monitoring framework would be more effective if it included key legal and policy indicators. The paper identifies priorities for technical legal assistance in implementing the WHO Global Action Plan for the Prevention and Control of NCDs 2013-2020. These include high-quality legal resources to assist countries to evaluate reform options, investment in legal capacity building, and global leadership to respond to the likely increase in requests by countries for technical legal assistance. We urge development agencies and other funders to recognise the need for development assistance in these areas. Throughout the paper, we point to global experience in dealing with HIV and draw out some relevant lessons for NCDs.

Non-communicable diseases, food and nutrition in Vietnam from 1975 to 2015: the burden and national response.

PubMed

Nguyen, Tuan T; Hoang, Minh V

2018-01-01

This review manuscript examines the burden and national response to non-communicable diseases (NCDs), food and nutrition security in Vietnam from 1975 to 2015. We extracted data from peer-reviewed manuscripts and reports of nationally representative surveys and related policies in Vietnam. In 2010, NCDs accounted for 318,000 deaths (72% of total deaths), 6.7 million years of life lost, and 14 million disability-adjusted life years in Vietnam. Cardiovascular diseases, cancers, chronic obstructive pulmonary disease, and diabetes mellitus were major contributors to the NCD burden. Adults had an increased prevalence of overweight and obesity (2.3% in 1993 to 15% in 2015) and hypertension (15% in 2002 to 20% in 2015). Among 25-64 years old in 2015, the prevalence of diabetes mellitus was 4.1% and the elevated blood cholesterol was 32%. Vietnamese had a low physical activity level, a high consumption of salt, instant noodles and sweetened non-alcoholic beverages as well as low consumption of fruit and vegetables and seafood. The alcohol consumption and smoking prevalence were high in men. Exposure to second-hand tobacco smoke was high in men, women and youths at home, work, and public places. In Vietnam, policies for NCD prevention and control need to be combined with strengthened law enforcement and increased program coverage. There were increased food production and improved dietary intake (e.g., energy intake and protein-rich foods thanked to appropriate economic, agriculture, and nutrition strategies. NCDs and their risk factors are emerging problems in Vietnam, which need both disease-specific and sensitive strategies in health and related sectors.

Ethnic and Gender Differentials in Non-Communicable Diseases and Self-Rated Health in Malaysia

PubMed Central

Teh, Jane K. L.; Tey, Nai Peng; Ng, Sor Tho

2014-01-01

Objectives This paper examines the ethnic and gender differentials in high blood pressure (HBP), diabetes, coronary heart disease (CHD), arthritis and asthma among older people in Malaysia, and how these diseases along with other factors affect self-rated health. Differentials in the prevalence of non-communicable diseases among older people are examined in the context of socio-cultural perspectives in multi-ethnic Malaysia. Methods Data for this paper are obtained from the 2004 Malaysian Population and Family Survey. The survey covered a nationally representative sample of 3,406 persons aged 50 and over, comprising three main ethnic groups (Malays, Chinese and Indians) and all other indigenous groups. Bivariate analyses and hierarchical logistic regression were used in the analyses. Results Arthritis was the most common non-communicable disease (NCD), followed by HBP, diabetes, asthma and CHD. Older females were more likely than males to have arthritis and HBP, but males were more likely to have asthma. Diabetes and CHD were most prevalent among Indians, while arthritis and HBP were most prevalent among the Indigenous groups. Older people were more likely to report poor health if they suffered from NCD, especially CHD. Controlling for socio-economic, health and lifestyle factors, Chinese were least likely to report poor health, whereas Indians and Indigenous people were more likely to do so. Chinese that had HBP were more likely to report poor health compared to other ethnic groups with the same disease. Among those with arthritis, Indians were more likely to report poor health. Conclusion Perceived health status and prevalence of arthritis, HBP, diabetes, asthma and CHD varied widely across ethnic groups. Promotion of healthy lifestyle, early detection and timely intervention of NCDs affecting different ethnic groups and gender with socio-cultural orientations would go a long way in alleviating the debilitating effects of the common NCDs among older people. PMID

Ethnic and gender differentials in non-communicable diseases and self-rated health in Malaysia.

PubMed

Teh, Jane K L; Tey, Nai Peng; Ng, Sor Tho

2014-01-01

This paper examines the ethnic and gender differentials in high blood pressure (HBP), diabetes, coronary heart disease (CHD), arthritis and asthma among older people in Malaysia, and how these diseases along with other factors affect self-rated health. Differentials in the prevalence of non-communicable diseases among older people are examined in the context of socio-cultural perspectives in multi-ethnic Malaysia. Data for this paper are obtained from the 2004 Malaysian Population and Family Survey. The survey covered a nationally representative sample of 3,406 persons aged 50 and over, comprising three main ethnic groups (Malays, Chinese and Indians) and all other indigenous groups. Bivariate analyses and hierarchical logistic regression were used in the analyses. Arthritis was the most common non-communicable disease (NCD), followed by HBP, diabetes, asthma and CHD. Older females were more likely than males to have arthritis and HBP, but males were more likely to have asthma. Diabetes and CHD were most prevalent among Indians, while arthritis and HBP were most prevalent among the Indigenous groups. Older people were more likely to report poor health if they suffered from NCD, especially CHD. Controlling for socio-economic, health and lifestyle factors, Chinese were least likely to report poor health, whereas Indians and Indigenous people were more likely to do so. Chinese that had HBP were more likely to report poor health compared to other ethnic groups with the same disease. Among those with arthritis, Indians were more likely to report poor health. Perceived health status and prevalence of arthritis, HBP, diabetes, asthma and CHD varied widely across ethnic groups. Promotion of healthy lifestyle, early detection and timely intervention of NCDs affecting different ethnic groups and gender with socio-cultural orientations would go a long way in alleviating the debilitating effects of the common NCDs among older people.

Addressing NCDs through research and capacity building in LMICs: lessons learned from tobacco control.

PubMed

Sturke, Rachel; Vorkoper, Susan; Duncan, Kalina; Levintova, Marya; Parascondola, Mark

2016-01-01

Confronting the global non-communicable diseases (NCDs) crisis requires a critical mass of scientists who are well versed in regional health problems and understand the cultural, social, economic, and political contexts that influence the effectiveness of interventions. Investments in global NCD research must be accompanied by contributions to local research capacity. The National Institutes of Health (NIH) and the Fogarty International Center have a long-standing commitment to supporting research capacity building and addressing the growing burden of NCDs in low- and middle-income countries. One program in particular, the NIH International Tobacco and Health Research and Capacity Building Program (TOBAC program), offers an important model for conducting research and building research capacity simultaneously. This article describes the lessons learned from this unique funding model and demonstrates how a relatively modest investment can make important contributions to scientific evidence and capacity building that could inform ongoing and future efforts to tackle the global burden of NCDs.

Addressing NCDs through research and capacity building in LMICs: lessons learned from tobacco control

PubMed Central

Sturke, Rachel; Vorkoper, Susan; Duncan, Kalina; Levintova, Marya; Parascondola, Mark

2016-01-01

Confronting the global non-communicable diseases (NCDs) crisis requires a critical mass of scientists who are well versed in regional health problems and understand the cultural, social, economic, and political contexts that influence the effectiveness of interventions. Investments in global NCD research must be accompanied by contributions to local research capacity. The National Institutes of Health (NIH) and the Fogarty International Center have a long-standing commitment to supporting research capacity building and addressing the growing burden of NCDs in low- and middle-income countries. One program in particular, the NIH International Tobacco and Health Research and Capacity Building Program (TOBAC program), offers an important model for conducting research and building research capacity simultaneously. This article describes the lessons learned from this unique funding model and demonstrates how a relatively modest investment can make important contributions to scientific evidence and capacity building that could inform ongoing and future efforts to tackle the global burden of NCDs. PMID:27545455

Chronic non-communicable diseases, risk and health promotion: social construction of VIGITEL participants.

PubMed

Mássimo, Erika de Azevedo Leitão; de Souza, Hercília Najara Ferreira; Freitas, Maria Imaculada de Fátima

2015-03-01

The dimension of choice and adherence to healthy lifestyles is in the area of social constructions made in representations of individuals and had not yet been included in the Surveillance of Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL) analysis systems. This article aims to understand, in individual narratives, representations contained in the trajectories of people's lives selected from the 2010 VIGITEL sample, in Belo Horizonte, Minas Gerais. It is a qualitative study based on Social Representation Theory. Thirty in-depth and open interviews with subjects selected from the 2010 VIGITEL sample were conducted in Belo Horizonte in the State of Minas Gerais. The Structural Analysis of Narrative technique was used to reveal the content of speeches. Age and heredity representations related to NCDs are part of the spectrum of current scientific information. Learning from childhood onwards is the basis of care. The lack of comprehension of the pathophysiology of NCDs, and the depth of representations of illness and death related to communicable diseases, is partly responsible for the difficulty of preventing NCDs.

[Assessment on the capacity for programs regarding chronic non-communicable diseases prevention and control, in China].

PubMed

Si, Xiang; Zhai, Yi; Shi, Xiaoming

2014-06-01

To assess the policies and programs on the capacity of prevention and control regarding non-communicable diseases (NCDs) at the Centers for Disease Control and Prevention (CDCs) at all levels and grass roots health care institutions, in China. On-line questionnaire survey was adopted by 3 352 CDCs at provincial, city and county levels and 1 200 grass roots health care institutions. 1) On policies: 75.0% of the provincial governments provided special funding for chronic disease prevention and control, whereas 19.7% city government and 11.3% county government did so. 2) Infrastructure:only 7.1% county level CDCs reported having a department taking care of NCD prevention and control. 8 263 staff members worked on NCDs prevention and control, accounting for 4.2% of all the CDCs' personnel. 40.2% CDCs had special funding used for NCDs prevention and control. 3)Capacity on training and guidance:among all the CDCs, 96.9% at provincial level, 50.3% at city level and 42.1% at county level had organized training on NCDs prevention and control. Only 48.3% of the CDCs at county level provided technical guidance for grass-roots health care institutions. 4) Capacities regarding cooperation and participation: 20.2% of the CDCs had experience in collaborating with mass media. 5) Surveillance capacity: 64.6% of the CDCs at county level implemented death registration, compare to less than 30.0% of CDCs at county level implemented surveillance programs on major NCDs and related risk factors. In the grass roots health care institutions, 18.6% implemented new stroke case reporting system but only 3.0% implemented program on myocardial infarction case reporting. 6) Intervention and management capacity: 36.1% and 32.2% of the CDCs conducted individualized intervention on hypertension and diabetes, while less than another 20% intervened into other NCDs and risk factors. More than 50% of the grass roots health care institutions carried follow-up survey on hypertension and diabetes. Rates

A shared framework for the common mental disorders and Non-Communicable Disease: key considerations for disease prevention and control.

PubMed

O'Neil, Adrienne; Jacka, Felice N; Quirk, Shae E; Cocker, Fiona; Taylor, C Barr; Oldenburg, Brian; Berk, Michael

2015-02-05

Historically, the focus of Non Communicable Disease (NCD) prevention and control has been cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM), cancer and chronic respiratory diseases. Collectively, these account for more deaths than any other NCDs. Despite recent calls to include the common mental disorders (CMDs) of depression and anxiety under the NCD umbrella, prevention and control of these CMDs remain largely separate and independent. In order to address this gap, we apply a framework recently proposed by the Centers for Disease Control with three overarching objectives: (1) to obtain better scientific information through surveillance, epidemiology, and prevention research; (2) to disseminate this information to appropriate audiences through communication and education; and (3) to translate this information into action through programs, policies, and systems. We conclude that a shared framework of this type is warranted, but also identify opportunities within each objective to advance this agenda and consider the potential benefits of this approach that may exist beyond the health care system.

The roles of community health workers in management of non-communicable diseases in an urban township

PubMed Central

Puoane, Thandi; Schneider, Helen; Levitt, Naomi S.; Steyn, Krisela

2014-01-01

Background Community health workers (CHWs) are increasingly being recognised as a crucial part of the health workforce in South Africa and other parts of the world. CHWs have taken on a variety of roles, including community empowerment, provision of services and linking communities with health facilities. Their roles are better understood in the areas of maternal and child health and infectious diseases (HIV infection, malaria and tuberculosis). Aim This study seeks to explore the current roles of CHWs working with non-communicable diseases (NCDs). Setting The study was conducted in an urban township in Cape Town, South Africa. Method A qualitative naturalistic research design utilising observations and in-depth interviews with CHWs and their supervisors working in Khayelitsha was used. Results CHWs have multiple roles in the care of NCDs. They act as health educators, advisors, rehabilitation workers and support group facilitators. They further screen for complications of illness and assist community members to navigate the health system. These roles are shaped both by expectations of the health system and in response to community needs. Conclusion This study indicates the complexities of the roles of CHWs working with NCDs. Understanding the actual roles of CHWs provides insights into not only the competencies required to enable them to fulfil their daily functions, but also the type of training required to fill the present gaps. PMID:26245419

Behavioral medicine and prevention of non-communicable diseases in China: current challenges and future directions.

PubMed

Ding, Ding; Zhong, Xuefeng; Lau, Joseph Tak-Fai; Oldenburg, Brian

2014-08-01

We describe the emergence of recent public health challenges in China, particularly those regarding lifestyle-related non-communicable diseases (NCDs). We also summarize some recent examples of behavioral medicine research and practice in relation to the prevention and control of NCDs in China. Finally, we describe recent changes in the public health system in China and how behavioral medicine research and practice can be incorporated into this system to address these public health challenges. We considered research and policy literature from both China and Western countries in order to evaluate the relevance of the field of behavioral medicine for addressing the rising NCDs in China. Rapid economic development and related social and environmental changes have brought about increasing wealth and lifestyle changes in China, along with new public health challenges related to the prevention and control of NCDs. The field of behavioral medicine has much to offer China in addressing these public health challenges. Although behavioral medicine research and practice are still at an early stage in China, there are encouraging signs of its development, particularly resulting from international collaborations with researchers from Western countries. The next stage of this field's development in China will involve increased integration of behavioral medicine into public health education, training, and the health system. However, this process of integration will need to build on China's traditional approaches to public health training, research, and practice. Although the field of behavioral medicine in public health is still in its infancy in China, we argue that the practice and principles of behavioral medicine are important for successfully addressing the substantial burden of NCDs now and in the future.

Investigating parents/caregivers financial burden of care for children with non-communicable diseases in Ghana.

PubMed

Abuosi, Aaron A; Adzei, Francis A; Anarfi, John; Badasu, Delali M; Atobrah, Deborah; Yawson, Alfred

2015-11-16

The introduction of the Ghana national health insurance scheme (NHIS) has led to progressive and significant increase in utilization of health services. However, the financial burden of caring for children with non-communicable diseases (NCDs) under the dispensation of the NHIS, especially during hospitalization, is less researched. This paper therefore sought to assess the financial burden parents/caregivers face in caring for children hospitalized with NCDs in Ghana, in the era of the Ghana NHIS. We conducted a cross-sectional survey of 225 parents or caregivers of children with NCDS hospitalized in three hospitals. Convenience sampling was used to select those whose children were discharged from hospital after hospitalization. Descriptive statistics such as frequencies and chi-square and logistic regression were used in data analysis. The main outcome variable was financial burden of care, proxied by cost of hospitalization. The independent variable included socio-economic and other indicators such as age, sex, income levels and financial difficulties faced by parents/caregivers. The study found that over 30 % of parents/caregivers spend more than Gh¢50 (25$) as cost of treatment of children hospitalized with NCDs; and over 40 % of parents/caregivers also face financial difficulties in providing health care to their wards. It was also found that even though many children hospitalized with NCDs have been covered by the NHIS, and that the NHIS indeed, provides significant financial relief to parents in the care of children with NCDs, children who are insured still pay out-of-pocket for health care, in spite of their insurance status. It was also found that there is less support from relatives and friends in the care of children hospitalized with NCDs, thus exacerbating parents/caregivers financial burden of caring for the children. Even though health insurance has proven to be of significant relief to the financial burden of caring for children with NCDs

Feasibility and yield of screening for non-communicable diseases among treated tuberculosis patients in Peru.

PubMed

Byrne, A L; Marais, B J; Mitnick, C D; Garden, F L; Lecca, L; Contreras, C; Yauri, Y; Garcia, F; Marks, G B

2018-01-01

The increasing prevalence of non-communicable diseases (NCDs) poses a major challenge to low- and middle-income countries. Patients' engagement with health services for anti-tuberculosis treatment provides an opportunity for screening for NCDs and for linkage to care. We explored the feasibility and yield of screening for NCDs in patients treated for tuberculosis (TB) in Lima, Peru, as part of a study focused on chronic respiratory sequelae. A representative sample of community controls was recruited from the same geographical area. Screening entailed taking a medical history and performing ambulatory blood pressure measurement and urinalysis. A total of 177 participants with previous TB (33 with multidrug-resistant TB) and 161 community controls were evaluated. There was an almost four-fold increased prevalence of self-reported diabetes mellitus (DM) in the TB group (adjusted prevalence ratio 3.66, 95%CI 1.68-8.01). Among those without self-reported DM, 3.3% had glycosuria, with a number needed to screen (NNS) of 31. The NNS to find one (new) case of hypertension or proteinuria in the TB group was respectively 24 and 5. Patient-centred care that includes pragmatic NCD screening is feasible in TB patients, and the treatment period provides a good opportunity to link patients to ongoing care.

Identifying patterns of non-communicable diseases in developed eastern coastal China: a longitudinal study of electronic health records from 12 public hospitals.

PubMed

Yu, Dehua; Shi, Jianwei; Zhang, Hanzhi; Wang, Zhaoxin; Lu, Yuan; Zhang, Bin; Pan, Ying; Wang, Bo; Sun, Pengfei

2017-10-05

Few studies have examined the spectrum and trends of non-communicable diseases (NCDs) in inpatients in eastern coastal China, which is transforming from an industrial economy to a service-oriented economy and is the most economically developed region in the country. This study aimed to dynamically elucidate the spectrum and characteristics of severe NCDs in eastern coastal China by analysing patients' longitudinal electronic health records (EHRs). To monitor the spectrum of NCDs dynamically, we extracted the EHR data from 12 general tertiary hospitals in eastern coastal China from 2003 to 2014. The rankings of and trends in the proportions of different NCDs presented by inpatients in different gender and age groups were calculated and analysed. We obtained a total sample of 1 907 484 inpatients with NCDs from 2003 to 2014, 50.05% of whom were men and 81.53% were aged 50 years or older. There was an increase in the number of total NCD inpatients in eastern coastal China from 2003 to 2014. However, the proportion of chronic respiratory diseases and cancer inpatients decreased over the 12-year period. Compared with men, women displayed a significant increase in the proportion of mental and behavioural disorders (p<0.001) over time. Additionally, digestive diseases and sensory organ diseases significantly decreased among men, but not women. The older group accounted for a larger and growing proportion of the NCD inpatients, and the most common conditions in this group were cerebral infarctions, coronary heart disease and hypertension. In addition, the proportion of 21-year-old to 50-year-old inpatients with diabetes, blood diseases or endocrine diseases skyrocketed from 2003 to 2014 (p<0.001). The burden of inpatients' NCDs increased rapidly, particularly among women and younger people. The NCD spectrum observed in eastern coastal China is a good source of evidence for developing prevention guides for regions experiencing transition. © Article author(s) (or their

Non communicable disease multimorbidity and associated health care utilization and expenditures in India: cross-sectional study.

PubMed

Pati, Sanghamitra; Agrawal, Sutapa; Swain, Subhashisa; Lee, John Tayu; Vellakkal, Sukumar; Hussain, Mohammad Akhtar; Millett, Christopher

2014-10-02

Non communicable disease (NCD) multimorbidity is increasingly becoming common in high income settings but little is known about its epidemiology and associated impacts on citizens and health systems in low and middle-income countries (LMICs). We aim to examine the socio-demographic distribution of NCD multimorbidity (≥2 diseases) and its implications for health care utilization and out-of-pocket expenditure (OOPE) in India. We analyzed cross-sectional nationally representative data from the World Health Organisaion Study on Global Ageing and Adult Health (WHO-SAGE), conducted in India during 2007. Multiple logistic regression was used to determine socio-demographic predictors of self-reported multimorbidity. A two part model was used to assess the relationship between number of NCDs and health care utilization including OOPE. 28.5% of the sample population had at least one NCD and 8.9% had NCD multimorbidity. The prevalence of multimorbidity increased from 1.3% in 18-29 year olds to 30.6% in those aged 70 years and above. Mean outpatient visits in the preceding 12 months increased from 2.2 to 6.2 and the percentage reporting an overnight hospital stay in the past 3 years increased from 9% to 29% in those with no NCD and ≥2 NCDs respectively (p <0.001).OOPE incurred during the last outpatient visit increased from INR 272.1 (95% CI = 249.0-295.2) in respondents with no NCDs to INR 454.1 (95% CI = 407.8-500.4) in respondents with ≥2 NCDs. However, we did not find an increase in OOPE during the last inpatient visit with number of NCDs (7865.9 INR for those with zero NCDs compared with 7301.3 for those with ≥2 NCDs). For both outpatient and inpatient OOPE, medicine constitutes the largest proportion of spending (70.7% for outpatient, 53.6% for inpatient visit), followed by spending for health care provider (14.0% for outpatient, 12.2% for inpatient visit). NCD multimorbidity is common in the Indian adult population and is associated with substantially

[The current situation and agendas in the prevention and control of non-communicable diseases in Vietnam].

PubMed

Hattori, Kiyoko; Uda, Hidenori; Hitomi, Yoshiaki; Yano, Ryosuke; Saijo, Takao; Watanabe, Naoyuki; Satomi, Maki; Yoshida, Aya; Oishi, Osamu; Yamashita, Tsuyoshi; Kamenosono, Akira

2018-01-01

Objectives　In Vietnam, the number of patients with non-communicable diseases (NCDs) has been increasing in recent years in association with the country's remarkable economic growth and corresponding changes in its population's lifestyle. The purposes of this research were to identify the challenges in the prevention and control of NCDs in Vietnam and to discuss countermeasures for NCDs in Vietnam and Japan.Methods　As a 2015 Regional Public Health Overall Promotion Project, an investigation team consisting of 11 public health physicians visited Hanoi, the capital of Vietnam, and its vicinities from January 11, 2016 to January 15, 2016. In Hanoi and its vicinities, we visited local healthcare institutions, such as the World Health Organization(WHO) Representative Office in Vietnam and Ministry of Health of Vietnam, and discussed the prevention and control of NCDs in Vietnam and Japan.Results　According to a survey in 2014, 73% of people of all age groups in Vietnam died from NCDs and the number of people suffering from NCDs has been sharply increasing in recent years. Major behavioral risk factors are dietary risks, tobacco smoke, alcohol use, and physical inactivity. There are four main problems with prevention and control of NCDs: 1) low awareness among the people of NCDs, 2) regional disparity of medical services, 3) shortage of healthcare staff members with professional knowledge, and 4) poor NCD surveillance.　In Vietnam, an NCD program with screening methods and medical guidelines for respective diseases was developed in 2002. However, it only covered tertiary prevention and did not fully describe the primary and secondary prevention measures. Currently, with the technical assistance of the WHO, the implementation of countermeasures emphasizing prevention and control to reduce NCD risk factors has only just begun.Conclusion　It was considered that educating each person in Vietnam on NCD prevention measures would be necessary and that a national policy

The role of law and governance reform in the global response to non-communicable diseases

PubMed Central

2014-01-01

Addressing non-communicable diseases (“NCDs”) and their risk-factors is one of the most powerful ways of improving longevity and healthy life expectancy for the foreseeable future – especially in low- and middle-income countries. This paper reviews the role of law and governance reform in that process. We highlight the need for a comprehensive approach that is grounded in the right to health and addresses three aspects: preventing NCDs and their risk factors, improving access to NCD treatments, and addressing the social impacts of illness. We highlight some of the major impediments to the passage and implementation of laws for the prevention and control of NCDs, and identify important practical steps that governments can take as they consider legal and governance reforms at country level. We review the emerging global architecture for NCDs, and emphasise the need for governance structures to harness the energy of civil society organisations and to create a global movement that influences the policy agenda at the country level. We also argue that the global monitoring framework would be more effective if it included key legal and policy indicators. The paper identifies priorities for technical legal assistance in implementing the WHO Global Action Plan for the Prevention and Control of NCDs 2013–2020. These include high-quality legal resources to assist countries to evaluate reform options, investment in legal capacity building, and global leadership to respond to the likely increase in requests by countries for technical legal assistance. We urge development agencies and other funders to recognise the need for development assistance in these areas. Throughout the paper, we point to global experience in dealing with HIV and draw out some relevant lessons for NCDs. PMID:24903332

Use and effectiveness of behavioural economics in interventions for lifestyle risk factors of non-communicable diseases: a systematic review with policy implications.

PubMed

Blaga, Oana M; Vasilescu, Livia; Chereches, Razvan M

2018-03-01

There is limited evidence on what behavioural economics strategies are effective and can be used to inform non-communicable diseases (NCDs) public health policies designed to reduce overeating, excessive drinking, smoking, and physical inactivity. The aim of the review is to examine the evidence on the use and effectiveness of behavioural economics insights on reducing NCDs lifestyle risk factors. Medline, Embase, PsycINFO, and EconLit were searched for studies published between January 2002 and July 2016 and reporting empirical, non-pharmacological, interventional research focusing on reducing at least one NCDs lifestyle risk factor by employing a behavioural economics perspective. We included 117 studies in the review; 67 studies had a low risk of bias and were classified as strong or very strong, 37 were moderate, and 13 were weak. We grouped studies by NCDs risk factors and conducted a narrative synthesis. The most frequent behavioural economics precepts used were incentives, framing, and choice architecture. We found inconclusive evidence regarding the success of behavioural economics strategies to reduce alcohol consumption, but we identified several strategies with policy-level implications which could be used to reduce smoking, improve nutrition, and increase physical activity. Most studies targeting tobacco consumption, physical activity levels, and eating behaviours from a behavioural economics perspective had promising results with potential impact on NCDs health policies. We recommend future studies to be implemented in real-life settings and on large samples from diverse populations.

Use of m-Health Technology for Preventive Interventions to Tackle Cardiometabolic Conditions and Other Non-Communicable Diseases in Latin America- Challenges and Opportunities.

PubMed

Beratarrechea, Andrea; Diez-Canseco, Francisco; Irazola, Vilma; Miranda, Jaime; Ramirez-Zea, Manuel; Rubinstein, Adolfo

2016-01-01

In Latin America, cardiovascular disease (CVD) mortality rates will increase by an estimated 145% from 1990 to 2020. Several challenges related to social strains, inadequate public health infrastructure, and underfinanced healthcare systems make cardiometabolic conditions and non-communicable diseases (NCDs) difficult to prevent and control. On the other hand, the region has high mobile phone coverage, making mobile health (mHealth) particularly attractive to complement and improve strategies toward prevention and control of these conditions in low- and middle-income countries. In this article, we describe the experiences of three Centers of Excellence for prevention and control of NCDs sponsored by the National Heart, Lung, and Blood Institute with mHealth interventions to address cardiometabolic conditions and other NCDs in Argentina, Guatemala, and Peru. The nine studies described involved the design and implementation of complex interventions targeting providers, patients and the public. The rationale, design of the interventions, and evaluation of processes and outcomes of each of these studies are described, together with barriers and enabling factors associated with their implementation. Copyright © 2016 Elsevier Inc. All rights reserved.

The effects of policy actions to improve population dietary patterns and prevent diet-related non-communicable diseases: scoping review

PubMed Central

Hyseni, L; Atkinson, M; Bromley, H; Orton, L; Lloyd-Williams, F; McGill, R; Capewell, S

2017-01-01

Poor diet generates a bigger non-communicable disease (NCD) burden than tobacco, alcohol and physical inactivity combined. We reviewed the potential effectiveness of policy actions to improve healthy food consumption and thus prevent NCDs. This scoping review focused on systematic and non-systematic reviews and categorised data using a seven-part framework: price, promotion, provision, composition, labelling, supply chain, trade/investment and multi-component interventions. We screened 1805 candidate publications and included 58 systematic and non-systematic reviews. Multi-component and price interventions appeared consistently powerful in improving healthy eating. Reformulation to reduce industrial trans fat intake also seemed very effective. Evidence on food supply chain, trade and investment studies was limited and merits further research. Food labelling and restrictions on provision or marketing of unhealthy foods were generally less effective with uncertain sustainability. Increasingly strong evidence is highlighting potentially powerful policies to improve diet and thus prevent NCDs, notably multi-component interventions, taxes, subsidies, elimination and perhaps trade agreements. The implications for policy makers are becoming clearer. PMID:27901036

The effects of policy actions to improve population dietary patterns and prevent diet-related non-communicable diseases: scoping review.

PubMed

Hyseni, L; Atkinson, M; Bromley, H; Orton, L; Lloyd-Williams, F; McGill, R; Capewell, S

2017-06-01

Poor diet generates a bigger non-communicable disease (NCD) burden than tobacco, alcohol and physical inactivity combined. We reviewed the potential effectiveness of policy actions to improve healthy food consumption and thus prevent NCDs. This scoping review focused on systematic and non-systematic reviews and categorised data using a seven-part framework: price, promotion, provision, composition, labelling, supply chain, trade/investment and multi-component interventions. We screened 1805 candidate publications and included 58 systematic and non-systematic reviews. Multi-component and price interventions appeared consistently powerful in improving healthy eating. Reformulation to reduce industrial trans fat intake also seemed very effective. Evidence on food supply chain, trade and investment studies was limited and merits further research. Food labelling and restrictions on provision or marketing of unhealthy foods were generally less effective with uncertain sustainability. Increasingly strong evidence is highlighting potentially powerful policies to improve diet and thus prevent NCDs, notably multi-component interventions, taxes, subsidies, elimination and perhaps trade agreements. The implications for policy makers are becoming clearer.

The socioeconomic distribution of non-communicable diseases in Europe: findings from the European Social Survey (2014) special module on the social determinants of health.

PubMed

McNamara, Courtney L; Balaj, Mirza; Thomson, Katie H; Eikemo, Terje A; Solheim, Erling F; Bambra, Clare

2017-02-01

A range of non-communicable diseases (NCDs) has been found to follow a social pattern whereby socioeconomic status predicts either a higher or lower risk of disease. Comprehensive evidence on the socioeconomic distribution of NCDs across Europe, however, has been limited. Using cross-sectional 2014 European Social Survey data from 20 countries, this paper examines socioeconomic inequalities in 14 self-reported NCDs separately for women and men: heart/circulatory problems, high blood pressure, back pain, arm/hand pain, foot/leg pain, allergies, breathing problems, stomach/digestion problems, skin conditions, diabetes, severe headaches, cancer, obesity and depression. Using education to measure socioeconomic status, age-controlled adjusted risk ratios were calculated and separately compared a lower and medium education group with a high education group. At the pooled European level, a social gradient in health was observed for 10 NCDs: depression, diabetes, obesity, heart/circulation problems, hand/arm pain, high blood pressure, breathing problems, severe headaches, foot/leg pain and cancer. An inverse social gradient was observed for allergies. Social gradients were observed among both genders, but a greater number of inequalities were observed among women. Country-specific analyses show that inequalities in NCDs are present everywhere across Europe and that inequalities exist to different extents for each of the conditions. This study provides the most up-to-date overview of socioeconomic inequalities for a large number of NCDs across 20 European countries for both women and men. Future investigations should further consider the diseases, and their associated determinants, for which socioeconomic differences are the greatest. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Non-communicable disease in HIV infection in low- and middle-income countries: gastrointestinal, hepatic, and nutritional aspects

PubMed Central

Kelly, Paul; Saloojee, Haroon; Chen, Jennifer Y; Chung, Raymond T

2014-01-01

The purpose of this review is to outline the interaction between HIV and non-communicable diseases (NCDs) affecting the gastrointestinal (GI) tract, liver, and nutritional disorders in low- and middle-income countries (LMICs), and to identify research priorities. Non-communicable GI tract disorders are only moderately influenced by HIV, and peptic ulceration is actually less common. However, the impact of HIV on GI cancers needs further investigation. HIV interacts strongly with environmental enteropathy, exacerbating malabsorption of nutrients and drugs. HIV has two major effects on non-communicable liver disease: drug-induced liver injury and non-alcoholic fatty liver disease (NAFLD) (particularly in persons of African genetic descent). The effect of HIV on nutrition was one of the first markers of the epidemic in the 1980s, and HIV continues to have major nutritional consequences. Childhood malnutrition and HIV frequently co-exist in some regions, e.g., southern Africa, resulting in powerful negative interactions with poorer responses to standard nutritional rehabilitation. HIV and nutritional care need to be better integrated, but many questions on how best to do this remain unanswered. Across the spectrum of gastrointestinal, hepatic, and nutritional disorders in HIV infection, there is increasing evidence that the microbiome may play an important role in disease pathogenesis, but work in this area, especially in LMICs, is in its infancy. PMID:25117963

Capacity assessment of selected health care facilities for the pilot implementation of Package for Essential Non-communicable Diseases (PEN) intervention in Ghana.

PubMed

Nyarko, Kofi Mensah; Ameme, Donne Kofi; Ocansey, Dennis; Commeh, Efua; Markwei, Mehitabel Tori; Ohene, Sally-Ann

2016-01-01

Non-communicable diseases (NCDs) continue to pose threats to human health and development worldwide. Though preventable, NCDs kill more people annually than all other diseases combined. The four major NCDs namely cardiovascular diseases, chronic respiratory diseases, diabetes and cancers share common modifiable risk factors. In order to prevent and control NCDs, Ghana has adopted the World Health Organisation Package for Essential NCD (WHO-PEN) intervention, to be piloted in selected districts before a nationwide scale-up. We assessed the capacity of these facilities for the implementation of the WHO-PEN pilot. We conducted a cross-sectional health facility-based survey using a multistage sampling technique. We collected data on human resource, equipment, service utilization, medicines availability and health financing through interviews and observation. Descriptive data analysis was performed and expressed in frequencies and relative frequencies. In all, 23 health facilities comprising two regional hospitals, three district hospitals, nine health centres and nine Community-based Health Planning and Services (CHPS) compounds from three regions were surveyed. All the hospitals had medical officers whilst 4 (44.4%) of the health centres had physician assistants. Health financing is mainly by the National Health Insurance Scheme (NHIS). None of the health facilities had spacers and only one health centre had oxygen cylinder, glucometer and nebulizer. Gaps exist in the human resource capacity and service delivery at the primary care levels, the focus of WHO-PEN intervention. Adequately equipping the primary health care level with trained health workers, basic equipment, medications and diagnostics will optimize the performance of WHO-PEN intervention when implemented.

The global impact of non-communicable diseases on macro-economic productivity: a systematic review.

PubMed

Chaker, Layal; Falla, Abby; van der Lee, Sven J; Muka, Taulant; Imo, David; Jaspers, Loes; Colpani, Veronica; Mendis, Shanthi; Chowdhury, Rajiv; Bramer, Wichor M; Pazoki, Raha; Franco, Oscar H

2015-05-01

Non-communicable diseases (NCDs) have large economic impact at multiple levels. To systematically review the literature investigating the economic impact of NCDs [including coronary heart disease (CHD), stroke, type 2 diabetes mellitus (DM), cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD)] on macro-economic productivity. Systematic search, up to November 6th 2014, of medical databases (Medline, Embase and Google Scholar) without language restrictions. To identify additional publications, we searched the reference lists of retrieved studies and contacted authors in the field. Randomized controlled trials, cohort, case-control, cross-sectional, ecological studies and modelling studies carried out in adults (>18 years old) were included. Two independent reviewers performed all abstract and full text selection. Disagreements were resolved through consensus or consulting a third reviewer. Two independent reviewers extracted data using a predesigned data collection form. Main outcome measure was the impact of the selected NCDs on productivity, measured in DALYs, productivity costs, and labor market participation, including unemployment, return to work and sick leave. From 4542 references, 126 studies met the inclusion criteria, many of which focused on the impact of more than one NCD on productivity. Breast cancer was the most common (n = 45), followed by stroke (n = 31), COPD (n = 24), colon cancer (n = 24), DM (n = 22), lung cancer (n = 16), CVD (n = 15), cervical cancer (n = 7) and CKD (n = 2). Four studies were from the WHO African Region, 52 from the European Region, 53 from the Region of the Americas and 16 from the Western Pacific Region, one from the Eastern Mediterranean Region and none from South East Asia. We found large regional differences in DALYs attributable to NCDs but especially for cervical and lung cancer. Productivity losses in the USA ranged from 88 million

Innovations in non-communicable diseases management in ASEAN: a case series.

PubMed

Lim, Jeremy; Chan, Melissa M H; Alsagoff, Fatimah Z; Ha, Duc

2014-01-01

Non-communicable diseases (NCDs) are reaching epidemic proportions worldwide and present an unprecedented challenge to economic and social development globally. In Southeast Asia, the challenges are exacerbated by vastly differing levels of health systems development and funding availability. In addressing the burden of NCDs, ASEAN nations need to fundamentally re-examine how health care services are structured and delivered and discover new models as undiscerning application of models from other geographies with different cultures and resources will be problematic. We sought to examine cases of innovation and identify critical success factors in NCD management in ASEAN. A qualitative design, focusing on in-depth interviews and site visits to explore the meanings and perceptions of participants regarding innovations in NCD against the backdrop of the overall context of delivering health care within the country's context was adopted. In total 12 case studies in six ASEAN countries were analysed. Primary interventions accounted for five of the total cases, whereas secondary interventions comprised four, and tertiary interventions three. Five core themes contributing to successful innovation for NCD management were identified. They include: 1) encourage better outcomes through leadership and support, 2) strengthen inter-disciplinary partnership, 3) community ownership is key, 4) recognise the needs of the people and what appeals to them, and 5) raise awareness through capacity building and increasing health literacy. Innovation is vital in enabling ASEAN nations to successfully address the growing crisis of NCDs. More of the same or wholesale transfers of developed world models will be ineffective and lead to financially unsustainable programmes or programmes lacking appropriate human capital. The case studies have demonstrated the transformative impact of innovation and identified key factors in successful implementation. Beyond pilot success, the bigger challenge is

Task shifting for non-communicable disease management in low and middle income countries--a systematic review.

PubMed

Joshi, Rohina; Alim, Mohammed; Kengne, Andre Pascal; Jan, Stephen; Maulik, Pallab K; Peiris, David; Patel, Anushka A

2014-01-01

One potential solution to limited healthcare access in low and middle income countries (LMIC) is task-shifting- the training of non-physician healthcare workers (NPHWs) to perform tasks traditionally undertaken by physicians. The aim of this paper is to conduct a systematic review of studies involving task-shifting for the management of non-communicable disease (NCD) in LMIC. A search strategy with the following terms "task-shifting", "non-physician healthcare workers", "community healthcare worker", "hypertension", "diabetes", "cardiovascular disease", "mental health", "depression", "chronic obstructive pulmonary disease", "respiratory disease", "cancer" was conducted using Medline via Pubmed and the Cochrane library. Two reviewers independently reviewed the databases and extracted the data. Our search generated 7176 articles of which 22 were included in the review. Seven studies were randomised controlled trials and 15 were observational studies. Tasks performed by NPHWs included screening for NCDs and providing primary health care. The majority of studies showed improved health outcomes when compared with usual healthcare, including reductions in blood pressure, increased uptake of medications and lower depression scores. Factors such as training of NPHWs, provision of algorithms and protocols for screening, treatment and drug titration were the main enablers of the task-shifting intervention. The main barriers identified were restrictions on prescribing medications and availability of medicines. Only two studies described cost-effective analyses, both of which demonstrated that task-shifting was cost-effective. Task-shifting from physicians to NPHWs, if accompanied by health system re-structuring is a potentially effective and affordable strategy for improving access to healthcare for NCDs. Since the majority of study designs reviewed were of inadequate quality, future research methods should include robust evaluations of such strategies.

Exploring knowledge and attitudes toward non-communicable diseases among village health teams in Eastern Uganda: a cross-sectional study.

PubMed

Ojo, Temitope Tabitha; Hawley, Nicola L; Desai, Mayur M; Akiteng, Ann R; Guwatudde, David; Schwartz, Jeremy I

2017-12-12

Community health workers are essential personnel in resource-limited settings. In Uganda, they are organized into Village Health Teams (VHTs) and are focused on infectious diseases and maternal-child health; however, their skills could potentially be utilized in national efforts to reduce the growing burden of non-communicable diseases (NCDs). We sought to assess the knowledge of, and attitudes toward NCDs and NCD care among VHTs in Uganda as a step toward identifying their potential role in community NCD prevention and management. We administered a knowledge, attitudes and practices questionnaire to 68 VHT members from Iganga and Mayuge districts in Eastern Uganda. In addition, we conducted four focus group discussions with 33 VHT members. Discussions focused on NCD knowledge and facilitators of and barriers to incorporating NCD prevention and care into their role. A thematic qualitative analysis was conducted to identify salient themes in the data. VHT members possessed some knowledge and awareness of NCDs but identified a lack of knowledge about NCDs in the communities they served. They were enthusiastic about incorporating NCD care into their role and thought that they could serve as effective conduits of knowledge about NCDs to their communities if empowered through NCD education, the availability of proper reporting and referral tools, and visible collaborations with medical personnel. The lack of financial remuneration for their role did not emerge as a major barrier to providing NCD services. Ugandan VHTs saw themselves as having the potential to play an important role in improving community awareness of NCDs as well as monitoring and referral of community members for NCD-related health issues. In order to accomplish this, they anticipated requiring context-specific and culturally adapted training as well as strong partnerships with facility-based medical personnel. A lack of financial incentivization was not identified to be a major barrier to such role

Cross-Sectional Association between Length of Incarceration and Selected Risk Factors for Non-Communicable Chronic Diseases in Two Male Prisons of Mexico City.

PubMed

Silverman-Retana, Omar; Lopez-Ridaura, Ruy; Servan-Mori, Edson; Bautista-Arredondo, Sergio; Bertozzi, Stefano M

2015-01-01

Mexico City prisons are characterized by overcrowded facilities and poor living conditions for housed prisoners. Chronic disease profile is characterized by low prevalence of self reported hypertension (2.5%) and diabetes (1.8%) compared to general population; 9.5% of male inmates were obese. There is limited evidence regarding on the exposure to prison environment over prisoner's health status; particularly, on cardiovascular disease risk factors. The objective of this study is to assess the relationship between length of incarceration and selected risk factors for non-communicable chronic diseases (NCDs). We performed a cross-sectional analysis using data from two large male prisons in Mexico City (n = 14,086). Using quantile regression models we assessed the relationship between length of incarceration and selected risk factors for NCDs; stratified analysis by age at admission to prison was performed. We found a significant negative trend in BMI and WC across incarceration length quintiles. BP had a significant positive trend with a percentage change increase around 5% mmHg. The greatest increase in systolic blood pressure was observed in the older age at admission group. This analysis provides insight into the relationship between length of incarceration and four selected risk factors for NCDs; screening for high blood pressure should be guarantee in order to identify at risk individuals and linked to the prison's health facility. It is important to assess prison environment features to approach potential risk for developing NCDs in this context.

Public policy, health system, and community actions against illness as platforms for response to NCDs in Tanzania: a narrative review.

PubMed

Metta, Emmy; Msambichaka, Beverly; Mwangome, Mary; Nyato, Daniel J; Dieleman, Marjolein; Haisma, Hinke; Klatser, Paul; Geubbels, Eveline

2014-01-01

Most low- and middle- income countries are facing a rise of the burden of non-communicable diseases (NCDs) alongside the persistent burden of infectious diseases. This narrative review aims to provide an inventory of how the existing policy environment, health system, and communities are addressing the NCDs situation in Tanzania and identify gaps for advancing the NCD research and policy agenda. A literature search was performed on PubMed and Google scholar with full text retrieval from HINARI of English language articles published between 2000 and 2012. Documents were read to extract information on what Tanzanian actors were doing that contributed to NCDs prevention, treatment, and control, and a narration was written out of these. Reference lists of all retrieved articles were searched for additional relevant articles. Websites of organizations active in the field of NCDs including the Government of Tanzania and WHO were searched for reports and grey literature. Lack of a specific and overarching NCD policy has slowed and fragmented the implementation of existing strategies to prevent and control NCDs and their determinants. The health system is not prepared to deal with the rising NCD burden although there are random initiatives to improve this situation. How the community is responding to these emerging conditions is still unknown, and the current health-seeking behavior and perceptions on the risk factors may not favor control of NCDs and their risk factors. There is limited information on the burden and determinants of NCDs to inform the design of an integrative and multisectorial policy. Evidence on effective interventions for NCD services in primary care levels and on community perceptions on NCDs and their care seeking is virtually absent. Research and public health interventions must be anchored in the policy, health system, and community platforms for a holistic response.

Monitoring and accountability for the Pacific response to the non-communicable diseases crisis.

PubMed

Tolley, Hilary; Snowdon, Wendy; Wate, Jillian; Durand, A Mark; Vivili, Paula; McCool, Judith; Novotny, Rachel; Dewes, Ofa; Hoy, Damian; Bell, Colin; Richards, Nicola; Swinburn, Boyd

2016-09-10

Non-communicable diseases (NCD) are the leading cause of premature death and disability in the Pacific. In 2011, Pacific Forum Leaders declared "a human, social and economic crisis" due to the significant and growing burden of NCDs in the region. In 2013, Pacific Health Ministers' commitment to 'whole of government' strategy prompted calls for the development of a robust, sustainable, collaborative NCD monitoring and accountability system to track, review and propose remedial action to ensure progress towards the NCD goals and targets. The purpose of this paper is to describe a regional, collaborative framework for coordination, innovation and application of NCD monitoring activities at scale, and to show how they can strengthen accountability for action on NCDs in the Pacific. A key component is the Dashboard for NCD Action which aims to strengthen mutual accountability by demonstrating national and regional progress towards agreed NCD policies and actions. The framework for the Pacific Monitoring Alliance for NCD Action (MANA) draws together core country-level components of NCD monitoring data (mortality, morbidity, risk factors, health system responses, environments, and policies) and identifies key cross-cutting issues for strengthening national and regional monitoring systems. These include: capacity building; a regional knowledge exchange hub; innovations (monitoring childhood obesity and food environments); and a robust regional accountability system. The MANA framework is governed by the Heads of Health and operationalised by a multi-agency technical Coordination Team. Alliance membership is voluntary and non-conditional, and aims to support the 22 Pacific Island countries and territories to improve the quality of NCD monitoring data across the region. In establishing a common vision for NCD monitoring, the framework combines data collected under the WHO Global Framework for NCDs with a set of action-orientated indicators captured in a NCD Dashboard for

Care-seeking patterns for fatal non-communicable diseases among women of reproductive age in rural northwest Bangladesh.

PubMed

Sikder, Shegufta S; Labrique, Alain B; Ullah, Barkat; Mehra, Sucheta; Rashid, Mahbubur; Ali, Hasmot; Jahan, Nusrat; Shamim, Abu A; West, Keith P; Christian, Parul

2012-08-15

Though non-communicable diseases contribute to an increasing share of the disease burden in South Asia, health systems in most rural communities are ill-equipped to deal with chronic illness. This analysis seeks to describe care-seeking behavior among women of reproductive age who died from fatal non-communicable diseases as recorded in northwest rural Bangladesh between 2001 and 2007. This analysis utilized data from a large population-based cohort trial in northwest rural Bangladesh. To conduct verbal autopsies of women who died while under study surveillance, physicians interviewed family members to elicit the biomedical symptoms that the women experienced as well as a narrative of the events leading to deaths. We performed qualitative textual analysis of verbal autopsy narratives for 250 women of reproductive age who died from non-communicable diseases between 2001 and 2007. The majority of women (94%) sought at least one provider for their illnesses. Approximately 71% of women first visited non-certified providers such as village doctors and traditional healers, while 23% first sought care from medically certified providers. After the first point of care, women appeared to switch to medically certified practitioners when treatment from non-certified providers failed to resolve their illness. This study suggests that treatment seeking patterns for non-communicable diseases are affected by many of the sociocultural factors that influence care seeking for pregnancy-related illnesses. Families in northwest rural Bangladesh typically delayed seeking treatment from medically certified providers for NCDs due to the cost of services, distance to facilities, established relationships with non-certified providers, and lack of recognition of the severity of illnesses. Most women did not realize initially that they were suffering from a chronic illness. Since women typically reached medically certified providers in advanced stages of disease, they were usually told that

An assessment of non-communicable diseases, diabetes, and related risk factors in the territory of American Samoa: a systems perspective.

PubMed

Ichiho, Henry M; Roby, Faiese T; Ponausuia, Elisapeta S; Aitaoto, Nia

2013-05-01

Non-communicable diseases (NCD) have been identified as a health emergency in the US-affiliated Pacific Islands (USAPI).1 This assessment, funded by the National Institutes of Health, was conducted in American Samoa and describes the burden of selected NCDs (ie, diabetes, heart disease, hypertension, stroke, and chronic kidney disease); and assesses the system of service capacity and activities regarding service delivery, data collection and reporting as well as identifies the issues needing to be addressed. Findings reveal that nutrient-poor diet, lack of physical activity, and other lifestyle behaviors are associated with overweight and obesity and subsequent NCDs that impact the morbidity and mortality of the population. The leading causes of death include heart disease, diabetes, cancer and stroke. Population surveys show that 93% of the adults are overweight or obese and 47% have diabetes. Among public school children, 44.6% are overweight or obese. Other data show that between 2006 and 2010, there was a 33% increase in the number of patients receiving hemodialysis. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address these NCDs. There is a paucity of health plans, policy and procedure manuals, coordination among providers, and lack of common standards of care. The combined administrative and clinical system of service needs were identified and prioritized. They include the need for a Territory-wide health strategy and plan, need for standards of care, and a need for collaborative team approach for the treatment and management of patients with diabetes and other chronic diseases.

Does health insurance mitigate inequities in non-communicable disease treatment? Evidence from 48 low- and middle-income countries.

PubMed

El-Sayed, Abdulrahman M; Palma, Anton; Freedman, Lynn P; Kruk, Margaret E

2015-09-01

Non-communicable diseases (NCDs) are the greatest contributor to morbidity and mortality in low- and middle-income countries (LMICs). However, NCD care is limited in LMICs, particularly among the disadvantaged and rural. We explored the role of insurance in mitigating socioeconomic and urban-rural disparities in NCD treatment across 48 LMICs included in the 2002-2004 World Health Survey (WHS). We analyzed data about ever having received treatment for diagnosed high-burden NCDs (any diagnosis, angina, asthma, depression, arthritis, schizophrenia, or diabetes) or having sold or borrowed to pay for healthcare. We fit multivariable regression models of each outcome by the interaction between insurance coverage and household wealth (richest 20% vs. poorest 50%) and urbanicity, respectively. We found that insurance was associated with higher treatment likelihood for NCDs in LMICs, and helped mitigate socioeconomic and regional disparities in treatment likelihood. These influences were particularly strong among women. Insurance also predicted lower likelihood of borrowing or selling to pay for health services among the poorest women. Taken together, insurance coverage may serve as an important policy tool in promoting NCD treatment and in reducing inequities in NCD treatment by household wealth, urbanicity, and sex in LMICs. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Capacity assessment of selected health care facilities for the pilot implementation of Package for Essential Non-communicable Diseases (PEN) intervention in Ghana

PubMed Central

Nyarko, Kofi Mensah; Ameme, Donne Kofi; Ocansey, Dennis; Commeh, Efua; Markwei, Mehitabel Tori; Ohene, Sally-Ann

2016-01-01

Introduction Non-communicable diseases (NCDs) continue to pose threats to human health and development worldwide. Though preventable, NCDs kill more people annually than all other diseases combined. The four major NCDs namely cardiovascular diseases, chronic respiratory diseases, diabetes and cancers share common modifiable risk factors. In order to prevent and control NCDs, Ghana has adopted the World Health Organisation Package for Essential NCD (WHO-PEN) intervention, to be piloted in selected districts before a nationwide scale-up. We assessed the capacity of these facilities for the implementation of the WHO-PEN pilot. Methods We conducted a cross-sectional health facility-based survey using a multistage sampling technique. We collected data on human resource, equipment, service utilization, medicines availability and health financing through interviews and observation. Descriptive data analysis was performed and expressed in frequencies and relative frequencies. Results In all, 23 health facilities comprising two regional hospitals, three district hospitals, nine health centres and nine Community-based Health Planning and Services (CHPS) compounds from three regions were surveyed. All the hospitals had medical officers whilst 4 (44.4%) of the health centres had physician assistants. Health financing is mainly by the National Health Insurance Scheme (NHIS). None of the health facilities had spacers and only one health centre had oxygen cylinder, glucometer and nebulizer. Conclusion Gaps exist in the human resource capacity and service delivery at the primary care levels, the focus of WHO-PEN intervention. Adequately equipping the primary health care level with trained health workers, basic equipment, medications and diagnostics will optimize the performance of WHO-PEN intervention when implemented. PMID:28149441

Framework legislation for non-communicable diseases: and for the Sustainable Development Goals?

PubMed Central

Magnusson, Roger S

2017-01-01

‘Framework legislation’ refers to legislation that sets out structures for governance and accountability or other processes for guiding the decisions and actions taken by government or the executive. Framework legislation for non-communicable diseases (NCDs) provides the opportunity for countries to focus their political commitment, to set national targets, and a time-frame for achieving them, and to create cross-sectoral governance structures for the development and implementation of innovative policies. Although they extend well beyond NCDs, the health-related Sustainable Development Goals (SDGs) create similar demands for effective national governance. A similar case might, therefore, be made for framework legislation for the health-related SDGs or for legislation to govern particular aspects, such as managing commercial relationships with the private sector or managing conflicts of interest. This article considers the possible benefits of framework legislation, including what issues might be appropriate for inclusion in a framework law. The absence of framework legislation should neither be seen as an excuse for inaction, nor is framework legislation a substitute for detailed regulation of areas such as sanitation and water quality, tobacco and alcohol control, food safety, essential medicines or poisons. The ultimate test for framework legislation will be its capacity to provide a catalyst for action and to accelerate progress towards national and global health goals. PMID:29082017

Towards a global framework for capacity building for non-communicable disease advocacy in low- and middle-income countries.

PubMed

Shilton, Trevor; Champagne, Beatriz; Blanchard, Claire; Ibarra, Lorena; Kasesmup, Vijj

2013-12-01

Non-communicable diseases (NCDs) represent an increasing proportion of morbidity and mortality throughout the world. Sustained advocacy, carried out by a skilled workforce, is an important strategy to realize the political will and implement the policy changes necessary to reduce the global burden of NCDs. Competencies for effective advocacy include a combination of scientific and technical as well as communication-based skills. Recognizing the need to build local capacity for NCD advocacy in low- and middle-income countries (LMIC), the International Union for Health Promotion and Education (IUHPE), the US Centers for Disease Control and Prevention (CDC), the National Heart Foundation of Australia and the InterAmerican Heart Foundation joined efforts to conduct two pilot advocacy courses, one in Thailand and one in Colombia. A Global Advisory Group engaged a Local Organizing Committee in each country to ensure the courses would meet the needs of the local stakeholders. While both courses contained a set of key competencies and helped participants develop joint strategies for moving forward with consensus advocacy targets, the courses differed in content and participant background depending on the local context. A key goal of the courses was to determine and describe the lessons learned and make recommendations for a framework to be used for future advocacy capacity-building activities in LMIC. The planning and execution of each course generated lessons in the following five areas that informed the development of a global framework for capacity building for NCD advocacy: 1) using a comprehensive theoretical framework to teach advocacy competencies, 2) engaging key stakeholders, 3) meeting local needs and priorities, 4) planning local logistics, and 5) ensuring the skills obtained through training are applied to sustained advocacy for NCDs.

The converging burdens of infectious and non-communicable diseases in rural-to-urban migrant Sub-Saharan African populations: a focus on HIV/AIDS, tuberculosis and cardio-metabolic diseases.

PubMed

Peer, Nasheeta

2015-01-01

Africa has the unenviable challenge of dealing with a double burden of disease: infectious diseases (IDs) such as HIV/AIDS and tuberculosis are high while non-communicable diseases (NCDs) are rapidly rising in the region. Populations with increased susceptibility to both include migrants. This review highlights the susceptibility of rural-to-urban migrants in Sub-Saharan Africa to the IDs of HIV/AIDS and tuberculosis, and to NCDs, particularly cardiovascular diseases. The disruption that occurs with migration is often accompanied by unhealthy exposures and environments. These include partaking in risky sexual practices and a subsequent greater risk for HIV infection in migrants than the general populations which contributes to the spread of the disease. Migrants frequently work and live in conditions that are poorly ventilated and overcrowded with suboptimal sanitation which increases their risk for tuberculosis. Considering that migrants have an increased risk of acquiring both HIV/AIDS and tuberculosis, and in view of the interaction between these diseases, they are likely to be at high risk for co-infection. They are also likely to facilitate the geographical spread of these infections and serve as conduits of disease dissemination to rural areas. Changes in lifestyle behaviours that accompany migration and urbanisation are exemplified primarily by shifts in physical activity and dietary patterns which promote the development of obesity, diabetes, hypertension and cardiovascular diseases. Urban living and employment is generally less physically exerting than rural routines; when migrants relocate from their rural residence they adapt to their new environment by significantly reducing their physical activity levels. Also, nutritional patterns among migrants in urban centres change rapidly with a shift to diets higher in fat, sugar and salt. Consequently, increases in weight, blood pressure and glucose levels have been reported within a year of migration

The prevalence and determinants of catastrophic health expenditures attributable to non-communicable diseases in low- and middle-income countries: a methodological commentary.

PubMed

Goryakin, Yevgeniy; Suhrcke, Marc

2014-11-07

Non-communicable diseases (NCDs), while traditionally considered a "rich world"-problem, have been spreading fast in low and middle income countries and by now account for a large share of mortality and ill-health in these countries, too. In addition to the disease burden, NCDs may also impose a substantial economic cost. One way in which NCDs might impact people's economic well-being may be via the out-of-pocket expenditures required to cover treatment and other costs associated with suffering from an NCD. In this commentary, we identify and discuss the methodological challenges related to cross-country comparison of-out-of-pocket and catastrophic out-of-pocket health care expenditures, attributable to NCDs, focussing on low and middle income countries. There is significant evidence of substantial cost burden placed by NCDs on patients living in low and middle income countries, with most of it being heavily concentrated among low socioeconomic status groups. However, a large variation in definition of COOPE between studies prevents cross-country comparison. In addition, as most studies tend to be observational, causal inferences are often not possible. This is further complicated by the cross-sectional nature of studies, small sample sizes, and/or limited duration of follow-up of patients. Most evidence for certain conditions (e.g., cancer) tends to be collected in high-income countries only. The definitions for COOPEs should be standardized as much as possible, to enable comparison of COOPE prevalence between countries. Prospective study design using larger samples representative of broader sections of local population, collecting better data on both direct and indirect treatment costs is also needed.

The lack of a non-communicable disease curriculum threatens the relevance of global public health education.

PubMed

Greenberg, Henry; Leeder, Stephen R; Shiau, Stephanie

2016-06-01

Non-communicable diseases (NCDs) such as cardiovascular diseases (CVDs), cancer, lung disease and diabetes are major public health challenges for emerging economies. However, Masters of Public Health (MPH) curricula in the USA do not provide germane coursework. To assess the availability of global NCD courses in MPH curricula, we searched the websites of the 50 schools accredited by the Council on Education for Public Health as of 1 July 2013. Our questionnaire queried availability of a global or international health department or track, availability of an NCD track, and the presence of courses on NCD, NCD risk factors, CVD or global NCDs as well as global health infrastructure. All schools had online course coursework available. Thirty-one schools (62%) offered a global/international health track or certificate; 38 (76%) offered an NCD course but only 4 (8%) offered a global NCD course. Of the schools with a global health program, none required an NCD course but all offered courses on global health economics or infrastructure. For public health schools to be aligned with global realities and to retain a leadership role, curricular initiatives that highlight the NCD epidemic and its societal complexities will need new emphasis. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Cross-Sectional Association between Length of Incarceration and Selected Risk Factors for Non-Communicable Chronic Diseases in Two Male Prisons of Mexico City

PubMed Central

Silverman-Retana, Omar; Lopez-Ridaura, Ruy; Servan-Mori, Edson; Bautista-Arredondo, Sergio; Bertozzi, Stefano M.

2015-01-01

Background Mexico City prisons are characterized by overcrowded facilities and poor living conditions for housed prisoners. Chronic disease profile is characterized by low prevalence of self reported hypertension (2.5%) and diabetes (1.8%) compared to general population; 9.5% of male inmates were obese. There is limited evidence regarding on the exposure to prison environment over prisoner’s health status; particularly, on cardiovascular disease risk factors. The objective of this study is to assess the relationship between length of incarceration and selected risk factors for non-communicable chronic diseases (NCDs). Methods and Findings We performed a cross-sectional analysis using data from two large male prisons in Mexico City (n = 14,086). Using quantile regression models we assessed the relationship between length of incarceration and selected risk factors for NCDs; stratified analysis by age at admission to prison was performed. We found a significant negative trend in BMI and WC across incarceration length quintiles. BP had a significant positive trend with a percentage change increase around 5% mmHg. The greatest increase in systolic blood pressure was observed in the older age at admission group. Conclusions This analysis provides insight into the relationship between length of incarceration and four selected risk factors for NCDs; screening for high blood pressure should be guarantee in order to identify at risk individuals and linked to the prison’s health facility. It is important to assess prison environment features to approach potential risk for developing NCDs in this context. PMID:26381399

A realist review of mobile phone-based health interventions for non-communicable disease management in sub-Saharan Africa.

PubMed

Opoku, Daniel; Stephani, Victor; Quentin, Wilm

2017-02-06

The prevalence of non-communicable diseases (NCDs) is increasing in sub-Saharan Africa. At the same time, the use of mobile phones is rising, expanding the opportunities for the implementation of mobile phone-based health (mHealth) interventions. This review aims to understand how, why, for whom, and in what circumstances mHealth interventions against NCDs improve treatment and care in sub-Saharan Africa. Four main databases (PubMed, Cochrane Library, Web of Science, and Google Scholar) and references of included articles were searched for studies reporting effects of mHealth interventions on patients with NCDs in sub-Saharan Africa. All studies published up until May 2015 were included in the review. Following a realist review approach, middle-range theories were identified and integrated into a Framework for Understanding the Contribution of mHealth Interventions to Improved Access to Care for patients with NCDs in sub-Saharan Africa. The main indicators of the framework consist of predisposing characteristics, needs, enabling resources, perceived usefulness, and perceived ease of use. Studies were analyzed in depth to populate the framework. The search identified 6137 titles for screening, of which 20 were retained for the realist synthesis. The contribution of mHealth interventions to improved treatment and care is that they facilitate (remote) access to previously unavailable (specialized) services. Three contextual factors (predisposing characteristics, needs, and enabling resources) influence if patients and providers believe that mHealth interventions are useful and easy to use. Only if they believe mHealth to be useful and easy to use, will mHealth ultimately contribute to improved access to care. The analysis of included studies showed that the most important predisposing characteristics are a positive attitude and a common language of communication. The most relevant needs are a high burden of disease and a lack of capacity of first-contact providers

A systematic review of interventions by healthcare professionals to improve management of non-communicable diseases and communicable diseases requiring long-term care in adults who are homeless.

PubMed

Hanlon, Peter; Yeoman, Lynsey; Gibson, Lauren; Esiovwa, Regina; Williamson, Andrea E; Mair, Frances S; Lowrie, Richard

2018-04-07

Identify, describe and appraise trials of interventions delivered by healthcare professionals to manage non-communicable diseases (NCDs) and communicable diseases that require long-term care or treatment (LT-CDs), excluding mental health and substance use disorders, in homeless adults. Systematic review of randomised controlled trials (RCTs), non-RCTs and controlled before-after studies. Interventions characterised using Effective Practice and Organisation of Care (EPOC) taxonomy. Quality assessed using EPOC risk of bias criteria. Database searches (MEDLINE, Embase, PsycINFO, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Applied Social Sciences Index and Abstracts (ASSIA) and Cochrane Central Register of Controlled Trials), hand searching reference lists, citation searches, grey literature and contact with study authors. Community. Adults (≥18 years) fulfilling European Typology of Homelessness criteria. Delivered by healthcare professionals managing NCD and LT-CDs. Primary outcome: unscheduled healthcare utilisation. mortality, biological markers of disease control, adherence to treatment, engagement in care, patient satisfaction, knowledge, self-efficacy, quality of life and cost-effectiveness. 11 studies were included (8 RCTs, 2 quasi-experimental and 1 feasibility) involving 9-520 participants (67%-94% male, median age 37-49 years). Ten from USA and one from UK. Studies included various NCDs (n=3); or focused on latent tuberculosis (n=4); HIV (n=2); hepatitis C (n=1) or type 2 diabetes (n=1). All interventions were complex with multiple components. Four described theories underpinning intervention. Three assessed unscheduled healthcare utilisation: none showed consistent reduction in hospitalisation or emergency department attendance. Six assessed adherence to specific treatments, of which four showed improved adherence to latent tuberculosis therapy. Three concerned education case management, all of which improved disease

[Association analysis between urbanization and non-communicable diseases and health-related behavior].

PubMed

Liu, G F; Sun, M P; Wang, Z Y; Jian, W Y

2016-06-18

To explore the association between different urbanization levels and non-communicable diseases (NCDs) in China and provide suggestions on designing relevant health policies in the urbanization process. We obtained health-related data from China Health and Retirement Longitudinal Study (CHARLS) 2011. This study used multistage sampling in design stage and covered 150 districts/counties, representative at the levels of the country. Geo-information system (GIS) method was used to get district areas data, and in combination with the Sixth National Census population data, we computed the population density which was regarded as the proxy variable of urbanization level in every city. The Logistic model was used to explore the effect of urbanization level on hypertension, diabetes, smoking, drinking, overweight and obesity. Compared with other cities in China, Shanghai and Shenzhen, with the population density of more than 3 000 people per km(2), were the cities with highest urbanization level. From the map of urbanization distribution across China, it was found that the urbanization levels of the northwestern districts were lower than those of the southeastern and coastal districts. The hypertension rate increased with the development of urbanization but there was no statistical significance. The proportion of patients with diabetes went up first and then saw a decrease trend in the process of urbanization. Drinking rate, overweight rate and obesity rate had similar trends, falling to their lowest point when urbanization level equaled 737,1 186 and 1 353 people per km(2) respectively and then experienced upward trends. By contrast, smoking rate declined first and then went up (the turning point was 1 029 people per km(2)). Different urbanization levels have different effects on NCDs, health-related behavior, overweight and obesity. Low urbanization level may create negative impact on health while high level can pose positive effect and increase people's health condition

Innovations in non-communicable diseases management in ASEAN: a case series

PubMed Central

Lim, Jeremy; Chan, Melissa M. H.; Alsagoff, Fatimah Z.; Ha, Duc

2014-01-01

Background Non-communicable diseases (NCDs) are reaching epidemic proportions worldwide and present an unprecedented challenge to economic and social development globally. In Southeast Asia, the challenges are exacerbated by vastly differing levels of health systems development and funding availability. In addressing the burden of NCDs, ASEAN nations need to fundamentally re-examine how health care services are structured and delivered and discover new models as undiscerning application of models from other geographies with different cultures and resources will be problematic. Objective We sought to examine cases of innovation and identify critical success factors in NCD management in ASEAN. Design A qualitative design, focusing on in-depth interviews and site visits to explore the meanings and perceptions of participants regarding innovations in NCD against the backdrop of the overall context of delivering health care within the country's context was adopted. Results In total 12 case studies in six ASEAN countries were analysed. Primary interventions accounted for five of the total cases, whereas secondary interventions comprised four, and tertiary interventions three. Five core themes contributing to successful innovation for NCD management were identified. They include: 1) encourage better outcomes through leadership and support, 2) strengthen inter-disciplinary partnership, 3) community ownership is key, 4) recognise the needs of the people and what appeals to them, and 5) raise awareness through capacity building and increasing health literacy. Conclusions Innovation is vital in enabling ASEAN nations to successfully address the growing crisis of NCDs. More of the same or wholesale transfers of developed world models will be ineffective and lead to financially unsustainable programmes or programmes lacking appropriate human capital. The case studies have demonstrated the transformative impact of innovation and identified key factors in successful

[Estimation of the impact of risk factors control on non-communicable diseases mortality, life expectancy and the labor force lost in China in 2030].

PubMed

Zeng, X Y; Li, Y C; Liu, J M; Liu, Y N; Liu, S W; Qi, J L; Zhou, M G

2017-12-06

Objective: To estimate the impact of risk factors control on non-communicable diseases (NCDs) mortality, life expectancy and the numbers of labor force lost in China in 2030. Methods: We used the results of China from Global Burden of Disease Study 2013, according to the correlation between death of NCDs and exposure of risk factors and the comparative risk assessment theory, to calculate population attributable fraction (PAF) and disaggregate deaths of NCDs into parts attributable and un-attributable. We used proportional change model to project risk factors exposure and un-attributable deaths of NCDs in 2030, then to get deaths of NCDs in 2030. Simulated scenarios according to the goals of global main NCDs risk factors control proposed by WHO were constructed to calculate the impact of risk factors control on NCDs death, life expectancy and the numbers of labor force lost. Results: If the risk factors exposure changed according to the trend of 1990 to 2013, compared to the numbers (8.499 million) and mortality rate (613.5/100 000) of NCDs in 2013, the death number (12.161 million) and mortality rate (859.2/100 000) would increase by 43.1% and 40.0% respectively in 2030, among which, ischemic stroke (increasing by 103.3% for death number and 98.8% for mortality rate) and ischemic heart disease (increasing by 85.0% for death number and 81.0% for mortality rate) would increase most quickly. If the risk factors get the goals in 2030, the NCDs deaths would reduce 2 631 thousands. If only one risk factor gets the goal, blood pressure (1 484 thousands NCDs deaths reduction), smoking (717 thousands reduction) and BMI (274 thousands reduction) would be the most important factors affecting NCDs death. Blood pressure control would have greater impact on ischemic heart disease (662 thousands reduction) and hemorrhagic stroke (449 thousands reduction). Smoking control would have the greatest effect on lung cancer (251 thousands reduction) and chronic obstructive pulmonary

Identifying and Describing the Impact of Cyclone, Storm and Flood Related Disasters on Treatment Management, Care and Exacerbations of Non-communicable Diseases and the Implications for Public Health.

PubMed

Ryan, Benjamin; Franklin, Richard C; Burkle, Frederick M; Aitken, Peter; Smith, Erin; Watt, Kerrianne; Leggat, Peter

2015-09-28

Over the last quarter of a century the frequency of natural disasters and the burden of non-communicable diseases (NCD) across the globe have been increasing. For individuals susceptible to, or chronically experiencing, NCDs this has become a significant risk. Disasters jeopardize access to essential treatment, care, equipment, water and food, which can result in an exacerbation of existing conditions or even preventable death. Consequently, there is a need to expand the public health focus of disaster management to include NCDs. To provide a platform for this to occur, this article presents the results from a systematic review that identifies and describes the impact of cyclone, flood and storm related disasters on those susceptible to, or experiencing, NCDs. The NCDs researched were: cardiovascular diseases; cancers; chronic respiratory diseases; and diabetes.   Four electronic publication databases were searched with a date limit of 31 December 2014. The data was analyzed through an aggregation of individual papers to create an overall data description. The data was then grouped by disease to describe the impact of a disaster on treatment management, exacerbation, and health care of people with NCDs. The PRISMA checklist was used to guide presentation of the research.   The review identified 48 relevant articles. All studies represented developed country data. Disasters interrupt treatment management and overall care for people with NCDs, which results in an increased risk of exacerbation of their illness or even death. The interruption may be caused by a range of factors, such as damaged transport routes, reduced health services, loss of power and evacuations. The health impact varied according to the NCD. For people with chronic respiratory diseases, a disaster increases the risk of acute exacerbation. Meanwhile, for people with cancer, cardiovascular diseases and diabetes there is an increased risk of their illness exacerbating, which can result in death

An Assessment of Non-Communicable Diseases, Diabetes, and Related Risk Factors in the Commonwealth of the Northern Mariana Islands: A Systems Perspective

PubMed Central

Robles, Becky; Aitaoto, Nia

2013-01-01

Non-communicable diseases (NCD) have been identified as a health emergency in the US-affiliated Pacific Islands (USAPI).1 This assessment, funded by the National Institutes of Health, was conducted in the Commonwealth of the Northern Mariana Islands (CNMI) and describes the burdens due to NCDs, with an emphasis on diabetes, and assesses the system of service capacity and current activities for service delivery, data collection and reporting as well as identifies the issues that need to be addressed. There has been a 22.7% decline in the population between 2000 and 2010. Findings of medical and health data reveal that the risk factors of lifestyle behaviors lead to overweight and obesity and subsequent NCD. The leading causes of death are heart disease, stroke and cancer. The 2009 BRFSS survey reveals that the prevalence rate for diabetes was 9.8%. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address these NCDs. There is no overall health plan to address NCDs or diabetes, there is little coordination between the medical care and public health staff, and there is no functional data system to identify, register, and track patients with diabetes. Based on the findings, priority issues and problems to be addressed for the administrative system and clinical system are identified. PMID:23900536

Addressing NCDs: A unifying agenda for sustainable development.

PubMed

Collins, Téa; Mikkelsen, Bente; Adams, Jennifer; Chestnov, Oleg; Evans, Tim; Feigl, Andrea; Nugent, Rachel; Pablos-Mendez, Ariel; Srivanichakorn, Supattra; Webb, Douglas

2017-10-28

Despite the mounting evidence that they impede social and economic development, increase inequalities, and perpetuate poverty, Noncommunicable diseases (NCDs) remain largely absent from the agendas of major development assistance initiatives. In addition, fundamental changes are developing in patterns of development assistance for health, and more of the burden for fighting NCDs is being placed on domestic budgets, thus increasing pressure on the most vulnerable countries. The paper argues, however, that a new day is coming. With the inclusion of NCDs and related targets in the 2030 Agenda for Sustainable Development, there is an unprecedented opportunity to explore linkages among the sustainable development goals, enhance policy coherence and advance the NCD agenda as part of sustainable development. International development partners (bilateral and multilateral) can help in this important effort to address NCDs and their shared risk factors by providing catalytic support to countries that are particularly vulnerable in terms of the disease burden but lack the resources (human, financial) and institutional arrangements to meet their commitments at national, regional, and global levels.

Preventable Lifestyle Risk Factors for Non-Communicable Diseases in the Pakistan Adolescents Schools Study 1 (PASS-1)

PubMed Central

Khawaja, Saleem; Motwani, Komal; Khoja, Adeel Akbar; Azam, Iqbal Syed; Fatmi, Zafar; Ali, Badar Sabir; Kadir, Muhammad Masood

2011-01-01

Objectives The rising burden of preventable risk factors for non-communicable diseases (NCDs) among adolescents is a major public health challenge worldwide. We identified the preventable risk factors for NCDs in adolescents. Methods In a school-based study, pre-tested structured questionnaires were completed by 414 adolescents (14 to 17 years) at six schools in three cities in Pakistan. The chi-squared test and adjusted odds ratio (aOR) with 95% confidence interval (CI) were calculated in a multinomial logistic regression analysis. Results Over 80% of the adolescents had unhealthy diets, and 54% were physically inactive. Most adolescents were exposed to passive smoking, and 14% were also current smokers. More than one-third of participants chewed betel nut, and one-quarter used oral tobacco. More girls were physically inactive (OR, 4.07; 95% CI, 2.69 to 6.17), whereas a greater proportion of boys were current smokers (OR, 2.17; 95% CI, 1.19 to 3.91), exposed to passive smoking (OR, 2.57; 95% CI, 1.72 to 3.83), and using betel nut (OR, 2.03; 95% CI, 1.34 to 3.06). Only 3.1% of the participants were without any preventable lifestyle risk factor for NCDs, and over 80% had ≥2 factors. Co-existence of risk factors was independently associated with fathers being blue-collar workers (aOR, 3.57; 95% CI, 1.07 to 11.92) and parents not treating their child fairly (aOR, 5.05; 95% CI, 1.29 to 19.78). Conclusions Most of the adolescents studied had preventable risk factors for NCDs. These results warrant comprehensive and integrated interventions to prevent lifestyle risk factors, and parents are front-line stakeholders. PMID:22020186

Profile of Risk Factors for Non-Communicable Diseases in Punjab, Northern India: Results of a State-Wide STEPS Survey

PubMed Central

Thakur, J. S.; Jeet, Gursimer; Pal, Arnab; Singh, Shavinder; Singh, Amarjit; Deepti, S. S.; Lal, Mohan; Gupta, Sanjay; Prasad, Rajender; Jain, Sanjay; Saran, Rajiv

2016-01-01

Background Efforts to assess the burden of non-communicable diseases risk factors has improved in low and middle-income countries after political declaration of UN High Level Meeting on NCDs. However, lack of reliable estimates of risk factors distribution are leading to delay in implementation of evidence based interventions in states of India. Methods A STEPS Survey, comprising all the three steps for assessment of risk factors of NCDs, was conducted in Punjab state during 2014–15. A statewide multistage sample of 5,127 residents, aged 18–69 years, was taken. STEPS questionnaire version 3.1 was used to collect information on behavioral risk factors, followed by physical measurements and blood and urine sampling for biochemical profile. Results Tobacco and alcohol consumption were observed in 11.3% (20% men and 0.9% women) and 15% (27% men and 0.3% women) of the population, respectively. Low levels of physical activity were recorded among 31% (95% CI: 26.7–35.5) of the participants. The prevalence of overweight and obesity was 28.6% (95% CI: 26.3–30.9) and 12.8% (95% CI: 11.2–14.4) respectively. Central obesity was higher among women (69.3%, 95% CI: 66.5–72.0) than men (49.5%, 95% CI: 45.3–53.7). Prevalence of hypertension in population was 40.1% (95% CI: 37.3–43.0). The mean sodium intake in grams per day for the population was 7.4 gms (95% CI: 7.2–7.7). The prevalence of diabetes (hyperglycemia), hypertriglyceridemia and hypercholesterolemia was 14.3% (95% CI: 11.7–16.8), 21.6% (95% CI: 18.5–25.1) and 16.1% (95% CI: 13.1–19.2), respectively. In addition, 7% of the population aged 40–69 years had a cardiovascular risk of ≥ 30% over a period of next 10 years. Conclusion We report high prevalence of risk factors of chronic non-communicable diseases among adults in Punjab. There is an urgent need to implement population, individual and programme wide prevention and control interventions to lower the serious consequences of NCDs. PMID

Tuberculosis Comorbidity with Communicable and Noncommunicable Diseases

PubMed Central

Bates, Matthew; Marais, Ben J.; Zumla, Alimuddin

2015-01-01

The 18th WHO Global Tuberculosis Annual Report indicates that there were an estimated 8.6 million incident cases of tuberculosis (TB) in 2012, which included 2.9 million women and 530,000 children. TB caused 1.3 million deaths including 320,000 human immunodeficiency virus (HIV)-infected people; three-quarters of deaths occurred in Africa and Southeast Asia. With one-third of the world’s population latently infected with Mycobacterium tuberculosis (Mtb), active TB disease is primarily associated with a break down in immune surveillance. This explains the strong link between active TB disease and other communicable diseases (CDs) or noncommunicable diseases (NCDs) that exert a toll on the immune system. Comorbid NCD risk factors include diabetes, smoking, malnutrition, and chronic lung disease, all of which have increased relentlessly over the past decade in developing countries. The huge overlap between killer infections such as TB, HIV, malaria, and severe viral infections with NCDs, results in a “double burden of disease” in developing countries. The current focus on vertical disease programs fails to recognize comorbidities or to encourage joint management approaches. This review highlights major disease overlaps and discusses the rationale for better integration of tuberculosis care with services for NCDs and other infectious diseases to enhance the overall efficiency of the public health responses. PMID:25659380

Knowledge of non-communicable diseases and practices related to healthy lifestyles among adolescents, in state schools of a selected educational division in Sri Lanka.

PubMed

Gamage, A U; Jayawardana, P L

2017-07-26

Behaviors established during the adolescence have life-long consequences to the onset of non-communicable diseases (NCDs) in later life. Therefore, it is essential to understand adolescents' knowledge and practices with the intention of developing preventive programs focusing on this age group. The objective of the study was to assess knowledge about selected NCDs, and lifestyle choices among school students aged 17-19 years in state schools of the Maharagama Educational Division, Sri Lanka. A descriptive, cross-sectional study was conducted among students aged 17-19 years attending state schools in Maharagama Education Division. A total of 634 students were selected from 9 schools conducting Advance Level classes. Stratified sampling was done based on stream of study and the number needed from each stratum was decided according to probability proportionate to size which was followed by cluster sampling within the strata to select the classes included. Data were collected using a self-administered-questionnaire on socio-demographic characteristics and economic status; lifestyle-related practices; knowledge on Non-Communicable -Diseases. Logistic regression was used to assess the associations. Proportion students with good overall knowledge was 43%(n = 272). Forty-three percent (n = 275) consumed a healthy diet, and 20%(n = 129) engaged in adequate physical activity 3%(n = 18) of students were current smokers and 12%(n = 73) current alcohol users 12%(n = 73). Overall "good" knowledge about NCDs was associated with being a science stream student(OR = 3.3; 95%CI:2.1-5.2). Healthy diet was associated with female sex (OR = 2.1; 95%CI: 1.5-3.0), and adequate physical activity with male sex (OR = 2.1; 95% CI:1.4-3.2), non-science-stream (OR = 2.1; 95%CI:1.2-3.7) and upper socio economic status (OR = 2.0; 95%CI:1.3-3.0). Non-smoking was associated with overall good knowledge (OR = 4.1; 95%CI:1.2-13.7) and female sex (OR = 0;95%CI:1.5-infinity

The Association Between Physical Activity, Mental Status, and Social and Family Support with Five Major Non-Communicable Chronic Diseases Among Elderly People: A Cross-Sectional Study of a Rural Population in Southern China.

PubMed

Huang, Xiang; Yang, Huajie; Wang, Harry H X; Qiu, Yongjun; Lai, Xiujuan; Zhou, Zhiheng; Li, Fangjian; Zhang, Liwei; Wang, Jiaji; Lei, Jimin

2015-10-21

Non-communicable chronic diseases (NCDs) have become the top threat in China. This study aimed to estimate the prevalence of major NCDs among the elderly population in rural areas in southern China and explore its associated social determinants. A multistage cluster random sampling methodology was adopted to select a total of 9245 rural elderly people from 3860 rural households in Guangdong Province. Interviews and physical examinations were performed to collect patient information. Descriptive and logistic regression analyses were conducted to explore factors associated with the presence of major NCDs. Over one-third (38.5%) of the study population suffered from five major NCDs. The grade of activities of daily living (ADL), mental status, and social relationship of elderly people without NCDs were better than those with NCDs. The major factors associated with the presence of NCDs among the elderly people included age (70-79 years group and 80-89 years group), education level (senior high/technical secondary school and junior college and above), mental status (concentration, enrichment and happy life and memory), relationship with neighbours, activities of daily living (ADL) (being able to climb three floors and bend over), physical activity, marital status (bereft), and living conditions (with offspring and family members). The study identified several social determinants associated with the presence of major NCDs. A higher level of family support and physical exercise might contribute to improved physical condition, mental status, and ADL among the elderly people in rural areas in southern China.

Social inequalities in the prevalence of self-reported chronic non-communicable diseases in Brazil: national health survey 2013.

PubMed

Malta, Deborah Carvalho; Bernal, Regina Tomie Ivata; de Souza, Maria de Fatima Marinho; Szwarcwald, Celia Landman; Lima, Margareth Guimarães; Barros, Marilisa Berti de Azevedo

2016-11-17

Considering the high socioeconomic inequalities in Brazil related to occurrence of morbidity and premature mortality, the objective of this study was to analyze inequalities in self-reported prevalence of Non-Communicable Diseases (NCD) and in the physical limitations caused by these diseases, among the Brazilian adult population, according to sociodemographic variables. This was a population-based cross-sectional study that analyzed information on 60,202 individuals who formed a representative sample of Brazilian adults interviewed for the National Health Survey 2013. Disparities by schooling levels and possession of private health insurance were assessed by calculating the prevalence (P) and prevalence ratio (PR) of each of the 13 NCDs and any associated limitations, while controlling for other socioeconomic and demographic variables. 45 % of the Brazilian adult population reported having at least one NCD. The prevalence ratio was greater among women (1.24 CI 1.21-1.28), individuals over 55 years of age, individuals with low schooling levels (illiterate and incomplete elementary education) (1.08 CI 1.02-1.14) and people living in the Southeast (1.10 CI 1.04-1.16), South (1.26 CI 1.19-1.34) and Central-West (1.11 CI 1.05-1.18) regions of the country. Diseases such as diabetes (1.42 CI 1.13-1.47), hypertension (1.17 CI 1.06-1.28), stroke (2.52 CI 1.74-3.66), arthritis (1.4 CI 1.11-1.77), spinal problems (1.39 CI .1.25-1.56), and chronic renal failure (1.65 CI 1.10.2.46), were more prevalent among adults with low education. For most NCDs, greater reports of limitations were associated with lower schooling levels and lack of private health insurance. Populations with lower schooling levels and lack of private health insurance present higher prevalence of various NCD and greater degrees of limitation due to these diseases. Results reveal the extent of social inequalities that persist with regard to occurrence and the impact of NCDs in Brazil.

Inequalities in non-communicable diseases between the major population groups in Israel: achievements and challenges.

PubMed

Muhsen, Khitam; Green, Manfred S; Soskolne, Varda; Neumark, Yehuda

2017-06-24

Israel is a high-income country with an advanced health system and universal health-care insurance. Overall, the health status has improved steadily over recent decades. We examined differences in morbidity, mortality, and risk factors for selected non-communicable diseases (NCDs) between subpopulation groups. Between 1975 and 2014, life expectancy in Israel steadily increased and is currently above the average life expectancy for the Organisation for Economic Co-operation and Development countries. Nevertheless, life expectancy has remained lower among Israeli Arabs than Israeli Jews, and this gap has recently widened. Age-adjusted mortality as a result of heart disease, stroke, or diabetes remains higher in Arabs, whereas age-adjusted incidence and mortality of cancer were higher among Jews. The prevalence of obesity and low physical activity in Israel is considerably higher among Arabs than Jews. Smoking prevalence is highest for Arab men and lowest for Arab women. Health inequalities are also evident by the indicators of socioeconomic position and in subpopulations, such as immigrants from the former Soviet Union, ultra-Orthodox Jews, and Bedouin Arabs. Despite universal health coverage and substantial improvements in the overall health of the Israeli population, substantial inequalities in NCDs persist. These differences might be explained, at least in part, by gaps in social determinants of health. The Ministry of Health has developed comprehensive programmes to reduce these inequalities between the major population groups. Sustained coordinated multisectoral efforts are needed to achieve a greater impact and to address other social inequalities. Copyright © 2017 Elsevier Ltd. All rights reserved.

Chronic non-communicable disease as a new epidemic in Africa: focus on The Gambia

PubMed Central

Omoleke, Semeeh A

2013-01-01

Introduction Recent epidemiological data suggest increasing burden of NCDs in many African countries but these diseases have not been given adequate attention due to the overwhelming burden of infectious diseases. There are no recent reports or studies on NCDs or related issues in The Gambia, consequently, this report intends to stimulate further epidemiological studies and also policy initiatives to forestall an epidemic. Methods Routine data on morbidity (in and out-patients), hospitalisation and mortality due to NCDs from health facilities in The Gambia between 2008 and 2011 were used. Other relevant data from multiple sources were also used. Results There is an increasing trend in the morbidity, hospitalisation and mortality due to NCDs in the Gambia between 2008 and 2011; 19.8%, 9.9% and 23.4% increments respectively. There is evidence of gender differences in these variables; more males suffer higher mortality from NCDs than females (p < 0.001). Furthermore, there is dearth of highly skilled health workforce as well as poor health infrastructures in The Gambia. Conclusion NCDs are becoming a public health challenge and the capacity to respond to NCDs in most African countries, particularly, The Gambia is very weak. There is need for a population-based study to accurately quantify the burden and their risk factors as a first step towards policy formulation and effective implementation. Furthermore, there is dire need for increased investments on health workforce as well as medical products and technologies towards addressing the consequences of this emerging epidemic. PMID:23646223

Mobile health for non-communicable diseases in Sub-Saharan Africa: a systematic review of the literature and strategic framework for research.

PubMed

Bloomfield, Gerald S; Vedanthan, Rajesh; Vasudevan, Lavanya; Kithei, Anne; Were, Martin; Velazquez, Eric J

2014-06-13

Mobile health (mHealth) approaches for non-communicable disease (NCD) care seem particularly applicable to sub-Saharan Africa given the penetration of mobile phones in the region. The evidence to support its implementation has not been critically reviewed. We systematically searched PubMed, Embase, Web of Science, Cochrane Central Register of Clinical Trials, a number of other databases, and grey literature for studies reported between 1992 and 2012 published in English or with an English abstract available. We extracted data using a standard form in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Our search yielded 475 citations of which eleven were reviewed in full after applying exclusion criteria. Five of those studies met the inclusion criteria of using a mobile phone for non-communicable disease care in sub-Saharan Africa. Most studies lacked comparator arms, clinical endpoints, or were of short duration. mHealth for NCDs in sub-Saharan Africa appears feasible for follow-up and retention of patients, can support peer support networks, and uses a variety of mHealth modalities. Whether mHealth is associated with any adverse effect has not been systematically studied. Only a small number of mHealth strategies for NCDs have been studied in sub-Saharan Africa. There is insufficient evidence to support the effectiveness of mHealth for NCD care in sub-Saharan Africa. We present a framework for cataloging evidence on mHealth strategies that incorporates health system challenges and stages of NCD care. This framework can guide approaches to fill evidence gaps in this area. Systematic review registration: PROSPERO CRD42014007527.

Political priority in the global fight against non–communicable diseases

PubMed Central

Maher, Anthony; Sridhar, Devi

2012-01-01

Background The prevalence of non–communicable diseases (NCDs) – such as cancer, diabetes, cardiovascular disease, and chronic respiratory diseases – is surging globally. Yet despite the availability of cost–effective interventions, NCDs receive less than 3% of annual development assistance for health to low and middle income countries. The top donors in global health – including the Bill and Melinda Gates Foundation, the US Government, and the World Bank – together commit less than 2% of their budgets to the prevention and control of NCDs. Why is there such meagre funding on the table for the prevention and control of NCDs? Why has a global plan of action aimed at halting the spread of NCDs been so difficult to achieve? Methods This paper aims to tackle these two interrelated questions by analysing NCDs through the lens of Jeremy Shiffman’s 2009 political priority framework. We define global political priority as ‘the degree to which international and national political leaders actively give attention to an issue, and back up that attention with the provision of financial, technical, and human resources that are commensurate with the severity of the issue’. Grounded in social constructionism, this framework critically examines the relationship between agenda setting and ‘objective’ factors in global health, such as the existence of cost–effective interventions and a high mortality burden. From a methodological perspective, this paper fits within the category of discipline configurative case study. Results We support Shiffman’s claim that strategic communication – or ideas in the form of issue portrayals – ought to be a core activity of global health policy communities. But issue portrayals must be the products of a robust and inclusive debate. To this end, we also consider it essential to recognise that issue portrayals reach political leaders through a vast array of channels. Raising the political priority of NCDs means engaging with

[Non-verbal communication in Alzheimer's disease].

PubMed

Schiaratura, Loris Tamara

2008-09-01

This review underlines the importance of non-verbal communication in Alzheimer's disease. A social psychological perspective of communication is privileged. Non-verbal behaviors such as looks, head nods, hand gestures, body posture or facial expression provide a lot of information about interpersonal attitudes, behavioral intentions, and emotional experiences. Therefore they play an important role in the regulation of interaction between individuals. Non-verbal communication is effective in Alzheimer's disease even in the late stages. Patients still produce non-verbal signals and are responsive to others. Nevertheless, few studies have been devoted to the social factors influencing the non-verbal exchange. Misidentification and misinterpretation of behaviors may have negative consequences for the patients. Thus, improving the comprehension of and the response to non-verbal behavior would increase first the quality of the interaction, then the physical and psychological well-being of patients and that of caregivers. The role of non-verbal behavior in social interactions should be approached from an integrative and functional point of view.

A New Wave of Vaccines for Non-Communicable Diseases: What Are the Regulatory Challenges?

PubMed

Darrow, Jonathan J; Kesselheim, Aaron S

2015-01-01

Vaccines represent one of the greatest achievements of medicine, dramatically reducing the incidence of serious or life-threatening infectious diseases and allowing people to live longer, healthier lives. As life expectancy has increased, however, the burden of non-communicable diseases (NCDs) such as cancer, hypertension, atherosclerosis, and diabetes has increased. This shifting burden of disease has heightened the already urgent need for therapies that treat or prevent NCDs, a need that is now being met with increased efforts to develop NCD vaccines. Like traditional vaccines, NCD vaccines work by modulating the human immune system, but target cells, proteins or other molecules that are associated with the NCD in question rather than pathogens or pathogen-infected cells. Efforts are underway to develop NCD vaccines to address not only cancer and hypertension, but also addiction, obesity, asthma, arthritis, psoriasis, multiple sclerosis, and Crohn's disease, among others. NCD vaccines present an interesting challenge for the U.S. Food and Drug Administration (FDA), which is tasked with approving new treatments on the basis of efficacy and safety. Should NCD vaccines be evaluated under the same analytic frame as traditional vaccines, or that of biologic drugs? Despite the borrowed nomenclature, NCD vaccines differ in important ways from infectious disease vaccines. Because infectious disease vaccines are generally administered to healthy individuals, often children, tolerance for adverse events is low and willingness to pay is limited. It is important to have infectious disease vaccines even for rare or eradicated disease (e.g., smallpox), in the event of an outbreak. The efficacy of infectious disease vaccines is generally high, and the vaccines convey population level benefits associated with herd immunity and potential eradication. The combination of substantial population-level benefits, low willingness to pay, and low tolerance for adverse events explains the

The protocol of a population-based prospective cohort study in southwest of Iran to analyze common non-communicable diseases: Shahrekord cohort study.

PubMed

Khaledifar, Arsalan; Hashemzadeh, Morteza; Solati, Kamal; Poustchi, Hosseion; Bollati, Valentina; Ahmadi, Ali; Kheiri, Soleiman; Samani, Keihan Ghatreh; Banitalebi, Mehdi; Sedehi, Morteza; Malekzadeh, Reza

2018-05-25

Prospective cohort studies are considered ideal choices to study multiple outcomes and risk factors for Non-communicable diseases (NCDs). Our aim is to set-up the protocol and analyze risk factors, incidence rates, prevalence, trends, and the models of environmental and genetic determinants of NCDs and their outcomes as well as interaction among such determinants. Shahrekord cohort study (SCS) that is a population-based prospective, study on a cohort consisting of people aged 35-70 years started in November 2015 in Iran. The sample size of the original cohort is at least 10,000 people. Annual follow-ups (200,000 person-year) of the cohort were designed to be conducted up to 2036. Exposures (a detailed demographic, socioeconomic, general health, quality of life, physical activity, anthropometric indexes, stress, health literacy, social capital, nutrition and eating habits, lifestyle, occupational history, living place, blindness, deafness, electrocardiography, lung capacities, blood pressure, sleep, smoking and alcohol, contact to animals, physical examinations and medical history, dental health, used drugs and supplements, glucose and lipid profiles) were measured by relevant standard methods and questionnaires. Incidence of common NCDs (cardiovascular diseases, cancer, gastrointestinal, respiratory, renal, hepatic, accidents, injury and neurological diseases), trend of risk factors, hospitalization, disability, and death were considered the outcomes of the cohort. The definition of disease was determined based on the International Classification of Diseases 10th version (ICD-10). Routine hematologic and biochemical tests were conducted and an all-inclusive biobank (blood, hair, nail, and urine specimens) of the cohort was stored for future studies. All steps of data collection and examinations are directly monitored by the quality control team. The SCS is a unique study conducted in southwest of Iran that is a notable work given the climate conditions and

Non-communicable diseases in Mozambique: risk factors, burden, response and outcomes to date

PubMed Central

2012-01-01

Mozambique is located on the East Coast of Africa bordering South Africa, Zimbabwe, Zambia, Malawi and Tanzania and is one of the poorest countries in the world. Currently NCDs account for 28% of deaths in Mozambique. Risk factors such as tobacco and alcohol use and poor diet are present in both urban and rural settings. Diseases such as hypertension and diabetes affect large proportions of the population, but people are often unaware of their condition or poorly managed. Data from studies on diabetes highlight the financial burden for NCD management in Mozambique for both the individual and health system. The National Strategic Plan for the prevention and control of NCDs in Mozambique has as its aim to create a positive environment to minimise or eliminate the exposure to risk factors and guarantee access to care. The plan has as its overall objective to reduce exposure to risk factors and morbidity and mortality due to NCDs and has 4 areas of intervention: 1) Prevention and health education with regards to NCDs; 2) Access to quality care, treatment and follow-up; 3) Prevention of disability and premature mortality and 4) Surveillance, research, monitoring and evaluation and advocacy for NCDs. The Ministry of Health developed projects for diabetes and hypertension and used these as key lessons that could then be applied to other NCDs. Mozambique, through political commitment from the Ministry of Health and the dedication of local champions, has been able to garner international support to improve care for people with diabetes and then use this to develop its National Plan for NCDs. Despite this increase in attention resources available do not match the challenge of NCDs in Mozambique. Mozambique’s experience provides a practical example of actions that can be undertaken in a resource poor country to tackle the emerging burden of NCDs. PMID:23171496

Views by health professionals on the responsiveness of commune health stations regarding non-communicable diseases in urban Hanoi, Vietnam: a qualitative study.

PubMed

Kien, Vu Duy; Van Minh, Hoang; Giang, Kim Bao; Ng, Nawi; Nguyen, Viet; Tuan, Le Thanh; Eriksson, Malin

2018-05-31

Primary health care plays an important role in addressing the burden of non-communicable diseases (NCDs) in low- and middle-income countries. In light of the rapid urbanization of Vietnam, this study aims to explore health professionals' views about the responsiveness of primary health care services at commune health stations, particularly regarding the increase of NCDs in urban settings. This qualitative study was conducted in Hanoi from July to August 2015. We implemented 19 in-depth interviews with health staff at four purposely selected commune health stations and conducted a brief inventory of existing NCD activities at these commune health stations. We also interviewed NCD managers at national, provincial, and district levels. The interview guides reflected six components of the WHO health system framework, including service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership/governance. A thematic analysis approach was applied to analyze the interview data in this study. Six themes, related to the six building blocks of the WHO health systems framework, were identified. These themes explored the responsiveness of commune health stations to NCDs in urban Hanoi. Health staff at commune health stations were not aware of the national strategy for NCDs. Health workers noted the lack of NCD informational materials for management and planning. The limited workforce at health commune stations would benefit from more health workers in general and those with NCD-specific training and skills. In addition, the budget for NCDs at commune health stations remains very limited, with large differences in the implementation of national targeted NCD programs. Some commune health stations had no NCD services available, while others had some programming. A lack of NCD treatment drugs was also noted, with a negative impact on the provision of NCD-related services at commune health stations. These themes were also

Prevalence of non-communicable diseases and access to health care and medications among Yazidis and other minority groups displaced by ISIS into the Kurdistan Region of Iraq.

PubMed

Cetorelli, Valeria; Burnham, Gilbert; Shabila, Nazar

2017-01-01

The increasing caseload of non-communicable diseases (NCDs) in displaced populations poses new challenges for humanitarian agencies and host country governments in the provision of health care, diagnostics and medications. This study aimed to characterise the prevalence of NCDs and better understand issues related to accessing care among Yazidis and other minority groups displaced by ISIS and currently residing in camps in the Kurdistan Region of Iraq. The study covered 13 camps managed by the Kurdish Board of Relief and Humanitarian Affairs. A systematic random sample of 1300 households with a total of 8360 members were interviewed between November and December 2015. Respondents were asked whether any household members had been previously diagnosed by a health provider with one or more of four common NCDs: hypertension, diabetes, cardiovascular disease and musculoskeletal conditions. For each household member with an NCD diagnosis, access to health care and medications were queried. Nearly one-third of households had at least one member who had been previously diagnosed with one or more of the four NCDs included in this study. Hypertension had the highest prevalence (19.4%; CI: 17.0-22.0), followed by musculoskeletal conditions (13.5%; CI: 11.4-15.8), diabetes (9.7%; CI: 8.0-11.7) and cardiovascular disease (6.3%; CI: 4.8-8.1). Individual NCD prevalence and multimorbidity increased significantly with age. Of those with an NCD diagnosis, 92.9% (CI: 88.9-95.5) had seen a health provider for this condition in the 3 months preceding the survey. In the majority of cases, care was sought from private clinics or hospitals rather than from the camp primary health care clinics. Despite the frequent access to health providers, 40.0% (CI: 34.4-46.0) were not taking prescribed medications, costs being the primary reason cited. New strategies are needed to strengthen health care provision for displaced persons with NCDs and ensure access to affordable medications.

Legal priorities for prevention of non-communicable diseases: innovations from WHO's Eastern Mediterranean region.

PubMed

Gostin, L O; Abou-Taleb, H; Roache, S A; Alwan, A

2017-03-01

Non-communicable diseases (NCDs) are the leading cause of death globally and in the World Health Organization's (WHO) Eastern Mediterranean region (EMR). This paper reports on a research collaboration between the WHO's Eastern Mediterranean Office (EMRO) and the O'Neill Institute for National and Global Health Law at Georgetown University that aims to identify (1) regionally relevant, cost-effective and affordable legal interventions to prevent NCDs, and (2) methods to strengthen implementation and enforcement. Comparative analysis of >200 international, regional and domestic interventions addressing key NCD risk factors, including tobacco, alcohol, diet and physical inactivity. Researchers searched legal and policy databases including the WHO Nutrition, Obesity and Physical Activity Database and drew upon academic commentary and 'grey' literature. Measures included evidence of impact; evidence of cost-effectiveness; and monitoring and enforcement mechanisms. Researchers identified many examples of legal interventions effectively reducing NCD risk factors. Key enabling factors for effective NCD-related laws include regulatory capacity; governance mechanisms promoting multisectoral collaboration and accountability; and tailoring interventions to local legal, economic and social contexts. In the EMR, and globally, law can be a cost-effective and affordable means of curbing underlying drivers of the NCD pandemic, such as rampant junk food marketing. Building upon this research, together with international and regional experts, EMRO has identified 10 priority interventions in the areas of tobacco control, unhealthy diets and NCD governance. The EMRO/O'Neill Institute partnership will develop guidance tools and capacity building initiatives to support Member States to harness the power of law to achieve population health improvements. Copyright © 2016. Published by Elsevier Ltd.

Addressing non-communicable diseases in the Seychelles: towards a comprehensive plan of action.

PubMed

Bovet, Pascal; Viswanathan, Bharathi; Shamlaye, Conrad; Romain, Sarah; Gedeon, Jude

2010-06-01

This article reviews the different steps taken during the past 20 years for the prevention and control of non-communicable diseases (NCDs) in the Seychelles. National surveys revealed high levels of several cardiovascular risk factors and prompted an organized response, starting with the creation of an NCD unit in the Ministry of Health. Information campaigns and nationwide activities raised awareness and rallied increasingly broad and high-level support. Significant policy was developed including comprehensive tobacco legislation and a School Nutrition Policy that bans soft drinks in schools. NCD guidelines were developed and specialized 'NCD nurses' were trained to complement doctors in district health centers. Decreasing smoking prevalence is evidence of success, but the raising so-called diabesity epidemic calls for an integrated multi-sector policy to mould an environment conducive to healthy behaviors. Essential components of these efforts include: effective surveillance mechanisms supplemented by focused research; generating broad interest and consensus; mobilizing leadership and commitment at all levels; involving local and international expertise; building on existing efforts; and seeking integrated, multi-disciplinary and multi-sector approaches.

Co-occurrence of behavioral risk factors of common non-communicable diseases among urban slum dwellers in Nairobi, Kenya.

PubMed

Haregu, Tilahun Nigatu; Oti, Samuel; Egondi, Thaddaeus; Kyobutungi, Catherine

2015-01-01

The four common non-communicable diseases (NCDs) account for 80% of NCD-related deaths worldwide. The four NCDs share four common risk factors. As most of the existing evidence on the common NCD risk factors is based on analysis of a single factor at a time, there is a need to investigate the co-occurrence of the common NCD risk factors, particularly in an urban slum setting in sub-Saharan Africa. To determine the prevalence of co-occurrence of the four common NCDs risk factors among urban slum dwellers in Nairobi, Kenya. This analysis was based on the data collected as part of a cross-sectional survey to assess linkages among socio-economic status, perceived personal risk, and risk factors for cardiovascular and NCDs in a population of slum dwellers in Nairobi, Kenya, in 2008-2009. A total of 5,190 study subjects were included in the analysis. After selecting relevant variables for common NCD risk factors, we computed the prevalence of all possible combinations of the four common NCD risk factors. The analysis was disaggregated by relevant background variables. The weighted prevalences of unhealthy diet, insufficient physical activity, harmful use of alcohol, and tobacco use were found to be 57.2, 14.4, 10.1, and 12.4%, respectively. Nearly 72% of the study participants had at least one of the four NCD risk factors. About 52% of the study population had any one of the four NCD risk factors. About one-fifth (19.8%) had co-occurrence of NCD risk factors. Close to one in six individuals (17.6%) had two NCD risk factors, while only 2.2% had three or four NCD risk factors. One out of five of people in the urban slum settings of Nairobi had co-occurrence of NCD risk factors. Both comprehensive and differentiated approaches are needed for effective NCD prevention and control in these settings.

The "expert patient" approach for non-communicable disease management in low and middle income settings: When the reality confronts the rhetoric.

PubMed

Xiao, Yue

2015-09-01

This paper seeks to explore the relevance between the Western "expert patient" rhetoric and the reality of non-communicable diseases (NCDs) control and management in low and middle income settings from the health sociological perspective. It firstly sets up a conceptual framework of the "expert patient" or the patient self-management approach, showing the rhetoric of the initiative in the developed countries. Then by examining the situation of NCDs control and management in low income settings, the paper tries to evaluate the possibilities of implementing the "expert patient" approach in these countries. Kober and Van Damme's study on the relevance of the "expert patient" for an HIV/AIDS program in low income settings is critically studied to show the relevance of the developed countries' rhetoric of the "expert patient" approach for the reality of developing countries. In addition, the MoPoTsyo diabetes peer educator program is analyzed to show the challenges faced by the low income countries in implementing patient self-management programs. Finally, applications of the expert patient approach in China are discussed as well, to remind us of the possible difficulties in introducing it into rural settings.

[Subnational analysis of probability of premature mortality caused by four main non-communicable diseases in China during 1990-2015 and " Health China 2030" reduction target].

PubMed

Zeng, X Y; Li, Y C; Liu, S W; Wang, L J; Liu, Y N; Liu, J M; Zhou, M G

2017-03-06

Objective: To investigate the current status, temporal trend and achieving Health China 2030 reduction target of probability of premature mortality caused by four main non-communicable diseases (NCDs) including cardiovascular and cerebrovascular diseases, tumour, diabetes, and chronic respiratory disease in China both at national and provincial level during 1990 to 2015. Methods: Using the results of Global Burden of Disease study 2015 (GBD 2015), according to the method of calculating premature mortality probability recommended by WHO, the current status and temporal trend by different gender from 1990 to 2015 were calculated, analyzed, and compared. Referring to " Health China 2030" target of reduction 30% of probability of premature mortality caused by major NCDs, we evaluated the difficulty of achieving the reduction target among provinces (not including Taiwan). Results: From 1990 to 2015, the probabilities of premature mortality in cardiovascular and cerebrovascular diseases, tumour, and chronic respiratory disease were all declined consistently for both men and women in China, the total of four main NCDs decreased from 30.69% to 18.54% with higher decreasing in women (from 25.97% to 12.40%) than that in men (from 34.94% to 24.19%). In 2015, the top five provinces in terms of probability of premature mortality caused by four main NCDs were Qinghai (28.81%), Tibet (25.88%), Guizhou (24.67%), Guangxi (23.56%), and Xinjiang (23.21%) in turn, while the top five provinces with the lowest probability were Shanghai (8.40%), Beijing (9.39%), Hong Kong (10.10%), Macao (10.31%), and Zhejiang (11.70%). If achieving the " Health China 2030" target, the probabilities of premature mortality in Qinghai and Tibet with the highest probability should decline to about 20.17%, and 18.12%, respectively in 2030, while 5.88%, and 6.57% in Shanghai and Beijing, respectively. From 1990 to 2015, the probability of premature mortality of four main NCDs declined by 2.00% a year on

Assessing the Health Care System of Services for Non-Communicable Diseases in the US-affiliated Pacific Islands: A Pacific Regional Perspective

PubMed Central

Ichiho, Henry M

2013-01-01

Non-communicable diseases (NCD) have been recognized as a major health threat in the US-affiliated Pacific Islands (USAPI) and health officials declared it an emergency.1 In an effort to address this emergent pandemic, the Pacific Chronic Disease Council (PCDC) conducted an assessment in all six USAPI jurisdictions which include American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Federated States of Micronesia (FSM), Guam, the Republic of the Marshall Islands (RMI) and the Republic of Palau to assess the capacity of the administrative, clinical, support, and data systems to address the problems of NCD. Findings reveal significant gaps in addressing NCDs across all jurisdictions and the negative impact of lifestyle behaviors, overweight, and obesity on the morbidity and mortality of the population. In addition, stakeholders from each site identified and prioritized administrative and clinical systems of service needs. PMID:23901369

Assessing the health care system of services for non-communicable diseases in the US-affiliated Pacific Islands: a Pacific regional perspective.

PubMed

Aitaoto, Nia; Ichiho, Henry M

2013-05-01

Non-communicable diseases (NCD) have been recognized as a major health threat in the US-affiliated Pacific Islands (USAPI) and health officials declared it an emergency.1 In an effort to address this emergent pandemic, the Pacific Chronic Disease Council (PCDC) conducted an assessment in all six USAPI jurisdictions which include American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Federated States of Micronesia (FSM), Guam, the Republic of the Marshall Islands (RMI) and the Republic of Palau to assess the capacity of the administrative, clinical, support, and data systems to address the problems of NCD. Findings reveal significant gaps in addressing NCDs across all jurisdictions and the negative impact of lifestyle behaviors, overweight, and obesity on the morbidity and mortality of the population. In addition, stakeholders from each site identified and prioritized administrative and clinical systems of service needs.

The contribution of housing and neighbourhood conditions to educational inequalities in non-communicable diseases in Europe: findings from the European Social Survey (2014) special module on the social determinants of health.

PubMed

McNamara, Courtney L; Balaj, Mirza; Thomson, Katie H; Eikemo, Terje A; Bambra, Clare

2017-02-01

Social gradients have been found across European populations, where less affluent groups are more often affected by poor housing and neighbourhood conditions. While poor housing and neighbourhood quality have been associated with a range of non-communicable diseases (NCDs), these conditions have rarely been applied to the examination of socioeconomic differences in NCDs. This study therefore asks ‘to what extent does adjusting for poor housing and neighbourhood conditions reduce inequalities in NCDs among men and women in Europe’? Our analysis used pooled-data from 20 European countries for women (n= 12 794) and men (n= 11 974), aged 25–75, from round 7 of the European Social Survey. Fourteen NCDs were investigated: heart/circulatory problems, high blood pressure, back pain, arm/hand pain, foot/leg pain, allergies, breathing problems, stomach/digestion problems, skin conditions, diabetes, severe headaches, cancer, obesity and depression. We used binary logistic regression models, stratified by gender, and adjusted rate ratios to examine whether educational inequalities in NCDs were reduced after controlling for poor housing and neighbourhood quality. Overall, we find that adjusting for poor housing and neighbourhood quality reduces inequalities in NCDs. While reductions were relatively small for some NCDs–for high blood pressure, reductions were found in the range of 0–4.27% among women—for other conditions reductions were more considerable. Controlling for both housing and neighbourhood conditions for example, reduced inequalities by 16–24% for severe headaches and 14–30% for breathing problems. Social gradients in poor housing and neighbourhood quality could be an important contributor to educational inequalities in some NCDs. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Strategic investments in non-communicable diseases (NCD) research in Africa: the GSK Africa NCD Open Lab.

PubMed

Hall, Matthew D; Dufton, Ann M; Katso, Roy M; Gatsi, Sally A; Williams, Pauline M; Strange, Michael E

2015-01-01

In March 2014, GSK announced a number of new strategic investments in Africa. One of these included investment of up to 25 million Pounds Sterling (£25 million) to create the world's first R&D Open Lab to increase understanding of non-communicable diseases (NCDs) in Africa. The vision is to create a new global R&D effort with GSK working in partnership with major funders, academic centres and governments to share expertise and resources to conduct high-quality research. The Africa NCD Open Lab will see GSK scientists collaborate with scientific research centres across Africa. An independent advisory board of leading scientists and clinicians will provide input to develop the strategy and selection of NCD research projects within a dynamic and networked open-innovation environment. It is hoped that these research projects will inform prevention and treatment strategies in the future and will enable researchers across academia and industry to discover and develop new medicines to address the specific needs of African patients.

Socioeconomic inequalities in catastrophic health expenditure and impoverishment associated with non-communicable diseases in urban Hanoi, Vietnam.

PubMed

Kien, Vu Duy; Van Minh, Hoang; Giang, Kim Bao; Dao, Amy; Tuan, Le Thanh; Ng, Nawi

2016-10-13

The catastrophic health expenditure and impoverishment indices offer guidance for developing appropriate health policies and intervention programs to decrease financial inequity. This study assesses socioeconomic inequalities in catastrophic health expenditure and impoverishment in relation to self-reported non-communicable diseases (NCD) in urban Hanoi, Vietnam. A cross-sectional survey was conducted from February to March 2013 in Hanoi, the capital city of Vietnam. We estimated catastrophic health expenditure and impoverishment using information from 492 slum household and 528 non-slum households. We calculated concentration indexes to assess socioeconomic inequalities in catastrophic health expenditure and impoverishment. Factors associated with catastrophic health expenditure and impoverishment were modelled using logistic regression analysis. The poor households in both slum and non-slum areas were at higher risk of experiencing catastrophic health expenditure, while only the poor households in slum areas were at higher risk of impoverishment because of healthcare spending. Households with at least one member reporting an NCD were significantly more likely to face catastrophic health expenditure (odds ratio [OR] = 2.4; 95 % confidence interval [CI], 1.8-4.0) and impoverishment (OR = 2.3; 95 % CI, 1.1-6.3) compared to households without NCDs. In addition, households in slum areas, with people age 60 years and above, and belonging to the poorest socioeconomic group were significantly associated with increased catastrophic health expenditure, while only households that lived in slum areas, and belonging to the poor or poorest socioeconomic groups were significantly associated with increased impoverishment because of healthcare spending. Financial interventions to prevent catastrophic health expenditure and impoverishment should target poor households, especially those with family members suffering from NCDs, with older members and those located in slum

Ultra-Processed Food Consumption and Chronic Non-Communicable Diseases-Related Dietary Nutrient Profile in the UK (2008⁻2014).

PubMed

Rauber, Fernanda; da Costa Louzada, Maria Laura; Steele, Eurídice Martínez; Millett, Christopher; Monteiro, Carlos Augusto; Levy, Renata Bertazzi

2018-05-09

We described the contribution of ultra-processed foods in the U.K. diet and its association with the overall dietary content of nutrients known to affect the risk of chronic non-communicable diseases (NCDs). Cross-sectional data from the U.K. National Diet and Nutrition Survey (2008⁻2014) were analysed. Food items collected using a four-day food diary were classified according to the NOVA system. The average energy intake was 1764 kcal/day, with 30.1% of calories coming from unprocessed or minimally processed foods, 4.2% from culinary ingredients, 8.8% from processed foods, and 56.8% from ultra-processed foods. As the ultra-processed food consumption increased, the dietary content of carbohydrates, free sugars, total fats, saturated fats, and sodium increased significantly while the content of protein, fibre, and potassium decreased. Increased ultra-processed food consumption had a remarkable effect on average content of free sugars, which increased from 9.9% to 15.4% of total energy from the first to the last quintile. The prevalence of people exceeding the upper limits recommended for free sugars and sodium increased by 85% and 55%, respectively, from the lowest to the highest ultra-processed food quintile. Decreasing the dietary share of ultra-processed foods may substantially improve the nutritional quality of diets and contribute to the prevention of diet-related NCDs.

Ultra-Processed Food Consumption and Chronic Non-Communicable Diseases-Related Dietary Nutrient Profile in the UK (2008–2014)

PubMed Central

Louzada, Maria Laura da Costa; Millett, Christopher; Monteiro, Carlos Augusto

2018-01-01

We described the contribution of ultra-processed foods in the U.K. diet and its association with the overall dietary content of nutrients known to affect the risk of chronic non-communicable diseases (NCDs). Cross-sectional data from the U.K. National Diet and Nutrition Survey (2008–2014) were analysed. Food items collected using a four-day food diary were classified according to the NOVA system. The average energy intake was 1764 kcal/day, with 30.1% of calories coming from unprocessed or minimally processed foods, 4.2% from culinary ingredients, 8.8% from processed foods, and 56.8% from ultra-processed foods. As the ultra-processed food consumption increased, the dietary content of carbohydrates, free sugars, total fats, saturated fats, and sodium increased significantly while the content of protein, fibre, and potassium decreased. Increased ultra-processed food consumption had a remarkable effect on average content of free sugars, which increased from 9.9% to 15.4% of total energy from the first to the last quintile. The prevalence of people exceeding the upper limits recommended for free sugars and sodium increased by 85% and 55%, respectively, from the lowest to the highest ultra-processed food quintile. Decreasing the dietary share of ultra-processed foods may substantially improve the nutritional quality of diets and contribute to the prevention of diet-related NCDs. PMID:29747447

An Assessment of Non-Communicable Diseases, Diabetes, and Related Risk Factors in the Federated States of Micronesia, State of Kosrae: A Systems Perspective

PubMed Central

Tolenoa, Nena; Taulung, Livinson; Mongkeya, Maria; Lippwe, Kipier; Aitaoto, Nia

2013-01-01

Non-communicable diseases (NCD) have been identified as a health emergency in the US-affiliated Pacific Islands (USAPI).1 This assessment, funded by the National Institutes of Health, was conducted in the Federated States of Micronesia, State of Kosrae and describes the burdens due to NCDs, including diabetes, and assesses the system of service capacity and current activities for service delivery, data collection and reporting as well as identifying the issues that need to be addressed. There has been a 13.9% decline in the population between 2000 and 2010. Findings reveal that the risk factors of poor diet, lack of physical activity, and lifestyle behaviors lead to overweight and obesity and subsequent NCD that are a significant factor in the morbidity and mortality of the population. Leading causes of death were due to nutrition and metabolic diseases followed by diseases of the circulatory system. Data from selected community programs show that the prevalence of overweight and obese participants ranged between 82% and 95% and the rate of reported diabetes ranged from 13% to 14%. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address these NCD. There is no functional data system that is able to identify, register, or track patients with diabetes. Priority administrative and clinical issues were identified that need to be addressed to begin to mitigate the burdens of NCDs among the residents of Kosrae State. PMID:23900387

An assessment of non-communicable diseases, diabetes, and related risk factors in the Federated States of Micronesia, State of Kosrae: a systems perspective.

PubMed

Ichiho, Henry M; Tolenoa, Nena; Taulung, Livinson; Mongkeya, Maria; Lippwe, Kipier; Aitaoto, Nia

2013-05-01

Non-communicable diseases (NCD) have been identified as a health emergency in the US-affiliated Pacific Islands (USAPI). This assessment, funded by the National Institutes of Health, was conducted in the Federated States of Micronesia, State of Kosrae and describes the burdens due to NCDs, including diabetes, and assesses the system of service capacity and current activities for service delivery, data collection and reporting as well as identifying the issues that need to be addressed. There has been a 13.9% decline in the population between 2000 and 2010. Findings reveal that the risk factors of poor diet, lack of physical activity, and lifestyle behaviors lead to overweight and obesity and subsequent NCD that are a significant factor in the morbidity and mortality of the population. Leading causes of death were due to nutrition and metabolic diseases followed by diseases of the circulatory system. Data from selected community programs show that the prevalence of overweight and obese participants ranged between 82% and 95% and the rate of reported diabetes ranged from 13% to 14%. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address these NCD. There is no functional data system that is able to identify, register, or track patients with diabetes. Priority administrative and clinical issues were identified that need to be addressed to begin to mitigate the burdens of NCDs among the residents of Kosrae State.

The impact of dietary risk factors on the burden of non-communicable diseases in Ethiopia: findings from the Global Burden of Disease study 2013.

PubMed

Melaku, Yohannes Adama; Temesgen, Awoke Misganaw; Deribew, Amare; Tessema, Gizachew Assefa; Deribe, Kebede; Sahle, Berhe W; Abera, Semaw Ferede; Bekele, Tolesa; Lemma, Ferew; Amare, Azmeraw T; Seid, Oumer; Endris, Kedir; Hiruye, Abiy; Worku, Amare; Adams, Robert; Taylor, Anne W; Gill, Tiffany K; Shi, Zumin; Afshin, Ashkan; Forouzanfar, Mohammad H

2016-12-16

The burden of non-communicable diseases (NCDs) has increased in sub-Saharan countries, including Ethiopia. The contribution of dietary behaviours to the NCD burden in Ethiopia has not been evaluated. This study, therefore, aimed to assess diet-related burden of disease in Ethiopia between 1990 and 2013. We used the 2013 Global Burden of Disease (GBD) data to estimate deaths, years of life lost (YLLs) and disability-adjusted life years (DALYs) related to eight food types, five nutrients and fibre intake. Dietary exposure was estimated using a Bayesian hierarchical meta-regression. The effect size of each diet-disease pair was obtained based on meta-analyses of prospective observational studies and randomized controlled trials. A comparative risk assessment approach was used to quantify the proportion of NCD burden associated with dietary risk factors. In 2013, dietary factors were responsible for 60,402 deaths (95% Uncertainty Interval [UI]: 44,943-74,898) in Ethiopia-almost a quarter (23.0%) of all NCD deaths. Nearly nine in every ten diet-related deaths (88.0%) were from cardiovascular diseases (CVD) and 44.0% of all CVD deaths were related to poor diet. Suboptimal diet accounted for 1,353,407 DALYs (95% UI: 1,010,433-1,672,828) and 1,291,703 YLLs (95% UI: 961,915-1,599,985). Low intake of fruits and vegetables and high intake of sodium were the most important dietary factors. The proportion of NCD deaths associated with low fruit consumption slightly increased (11.3% in 1990 and 11.9% in 2013). In these years, the rate of burden of disease related to poor diet slightly decreased; however, their contribution to NCDs remained stable. Dietary behaviour contributes significantly to the NCD burden in Ethiopia. Intakes of diet low in fruits and vegetables and high in sodium are the leading dietary risks. To effectively mitigate the oncoming NCD burden in Ethiopia, multisectoral interventions are required; and nutrition policies and dietary guidelines should be

Tracing Africa's progress towards implementing the Non-Communicable Diseases Global action plan 2013-2020: a synthesis of WHO country profile reports.

PubMed

Nyaaba, Gertrude Nsorma; Stronks, Karien; de-Graft Aikins, Ama; Kengne, Andre Pascal; Agyemang, Charles

2017-04-05

Half of the estimated annual 28 million non-communicable diseases (NCDs) deaths in low- and middle-income countries (LMICs) are attributed to weak health systems. Current health policy responses to NCDs are fragmented and vertical particularly in the African region. The World Health Organization (WHO) led NCDs Global action plan 2013-2020 has been recommended for reducing the NCD burden but it is unclear whether Africa is on track in its implementation. This paper synthesizes Africa's progress towards WHO policy recommendations for reducing the NCD burden. Data from the WHO 2011, 2014 and 2015 NCD reports were used for this analysis. We synthesized results by targets descriptions in the three reports and included indicators for which we could trace progress in at least two of the three reports. More than half of the African countries did not achieve the set targets for 2015 and slow progress had been made towards the 2016 targets as of December 2013. Some gains were made in implementing national public awareness programmes on diet and/or physical activity, however limited progress was made on guidelines for management of NCD and drug therapy and counselling. While all regions in Africa show waning trends in fully achieving the NCD indicators in general, the Southern African region appears to have made the least progress while the Northern African region appears to be the most progressive. Our findings suggest that Africa is off track in achieving the NCDs indicators by the set deadlines. To make sustained public health gains, more effort and commitment is urgently needed from governments, partners and societies to implement these recommendations in a broader strategy. While donors need to suit NCD advocacy with funding, African institutions such as The African Union (AU) and other sub-regional bodies such as West African Health Organization (WAHO) and various country offices could potentially play stronger roles in advocating for more NCD policy efforts in Africa.

The 2011 United Nations high-level meeting on non-communicable diseases: the Africa agenda calls for a 5-by-5 approach.

PubMed

Mensah, G A; Mayosi, B M

2012-11-08

The High Level Meeting of the 66th Session of the United Nations General Assembly was held in September 2011. The Political Declaration issued at the meeting focused the attention of world leaders and the global health community on the prevention and control of noncommunicable diseases (NCDs). The four major NCDs (cardiovascular diseases, cancer, diabetes and chronic respiratory diseases) and their four risk factors (tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol) constitute the target of the '4-by-4' approach, which is also supported by national and international health organisations. We argue that while preventing these eight NCDs and risk factors is also important in Africa, it will not be enough. A '5-by-5' strategy is needed, addressing neuropsychiatric disorders as the fifth NCD; and transmissible agents that underlie the neglected tropical diseases and other NCDs as the fifth risk factor. These phenomena cause substantial preventable death and disability, and must therefore be prioritised.

Healthy people and healthy profits? Elaborating a conceptual framework for governing the commercial determinants of non-communicable diseases and identifying options for reducing risk exposure.

PubMed

Buse, Kent; Tanaka, Sonja; Hawkes, Sarah

2017-06-15

Non-communicable diseases (NCDs) represent a significant threat to human health and well-being, and carry significant implications for economic development and health care and other costs for governments and business, families and individuals. Risks for many of the major NCDs are associated with the production, marketing and consumption of commercially produced food and drink, particularly those containing sugar, salt and transfats (in ultra-processed products), alcohol and tobacco. The problems inherent in primary prevention of NCDs have received relatively little attention from international organizations, national governments and civil society, especially when compared to the attention paid to secondary and tertiary prevention regimes (i.e. those focused on provision of medical treatment and long-term clinical management). This may in part reflect that until recently the NCDs have not been deemed a priority on the overall global health agenda. Low political priority may also be due in part to the complexity inherent in implementing feasible and acceptable interventions, such as increased taxation or regulation of access, particularly given the need to coordinate action beyond the health sector. More fundamentally, governing determinants of risk frequently brings public health into conflict with the interests of profit-driven food, beverage, alcohol and tobacco industries. We use a conceptual framework to review three models of governance of NCD risk: self-regulation by industry; hybrid models of public-private engagement; and public sector regulation. We analyse the challenges inherent in each model, and review what is known (or not) about their impact on NCD outcomes. While piecemeal efforts have been established, we argue that mechanisms to control the commercial determinants of NCDs are inadequate and efforts at remedial action too limited. Our paper sets out an agenda to strengthen each of the three governance models. We identify reforms that will be needed

Increase in premature mortality due to non-communicable diseases in Sri Lanka during the first decade of the twenty-first century.

PubMed

Ediriweera, Dileepa Senajith; Karunapema, Palitha; Pathmeswaran, Arunasalam; Arnold, Mahendra

2018-05-02

Globally, non-communicable diseases (NCD) are the leading cause of death and more than 40% of NCD deaths are premature occurring before the age of 70 years. In 2012, World Health Assembly declared its commitment to reduce premature NCD mortality by 25% from 2010 to 2025. The trend of premature NCD deaths in Sri Lanka has not been assessed and thus this study was done to assess it between 2001 to 2010. Deaths due to cardiovascular diseases, cancers, chronic respiratory diseases and diabetes were studied. Premature NCD mortality was assessed using unconditional probability of dying (UPoD) due to NCDs among those aged 30 to 70 years. Number of relevant premature NCD deaths that occurred in each 5-year age interval and the respective mid-year population was used to calculate UPoD. During the period of 2001 to 2010, premature NCD mortality in Sri Lanka increased from 15·8% to 19·1% and males showed higher mortality compared to females throughout the period. Highest mortality was due to cardiovascular diseases followed by cancer and diabetes and all three showed an increasing trend. Chronic respiratory diseases showed an increase until 2004 and dropped thereafter. Among the four NCDs, diabetes revealed the most marked increasing trend in premature mortality during this period. The data revealed an increasing trend of premature NCD mortality in Sri Lanka between 2001 and 2010 although it has a relatively lower premature NCD mortality rate in the South-East Asian Region. Therefore, reducing premature NCD mortality by 25% from 2010 to 2025 is likely to be a rather challenging task in Sri Lanka and policy level changes need to be taken to achieve this target.

CHILD DEVELOPMENT STUDY (NCDS): CHILDREN OF THE BRITISH NCDS

EPA Science Inventory

The National Child Development Study (NCDS) is one of Britain's birth cohort studies, surveying all the children born in U.K. in a week of March 1958 (a complete enumeration, not a sample). They have been re-interviewed several times over the past forty years: first, at the time ...

Some Aspects of Communicable and Non-Communicable Diseases in Pacific Island Countries

ERIC Educational Resources Information Center

Gani, Azmat

2009-01-01

This study provides an overview of the incidence of the communicable and non-communicable diseases in Pacific Island countries. Available health statistics confirms that children continue to die annually due to neonatal causes, diarrhoeal diseases, pneumonia and measles. The adult population in several countries reveals presence and emergence of…

Non-communicable diseases and the social determinants of health in the Nordic countries: Findings from the European Social Survey (2014) special module on the social determinants of health.

PubMed

Balaj, Mirza; Huijts, Tim; McNamara, Courtney L; Stornes, Per; Bambra, Clare; Eikemo, Terje A

2017-03-01

Comparative studies examining non-communicable diseases (NCDs) and determinants of health in the Nordic countries are scarce, outdated and focus only on a limited range of NCDs and health determinants. This study is the first to present a comprehensive overview of the distribution of social and behavioural determinants of health and of physical and mental NCDs in the Nordic population. We examined regional, country and gender differences for 17 health outcomes and 20 determinants of health. We use data from the 7th wave of the European Social Survey. All results were age-standardised by weighting up or down the unstandardized (crude) prevalence rates for five year age groups in each country to a common standard. We present pooled estimates for the combined regional samples as well as country-specific results for the Nordic region. Overall, the population of the Nordic region reported among the highest prevalence for one or both genders in 10 out of 17 health outcomes. Despite being the region with the highest prevalence for most health outcomes, overall self-rated health levels tend to be better in the Nordic region. Similarly, we found that the Nordic countries adhere to a healthier lifestyle and have better access to health care. Future studies should consider investigating further the association between health outcomes and determinants of health and how they are distributed in the Nordic societies.

The contribution of urbanization to non-communicable diseases: Evidence from 173 countries from 1980 to 2008.

PubMed

Goryakin, Yevgeniy; Rocco, Lorenzo; Suhrcke, Marc

2017-08-01

It is widely believed that the expanding burden of non-communicable diseases (NCDs) is in no small part the result of major macro-level determinants. We use a large amount of new data, to explore in particular the role played by urbanization - the process of the population shifting from rural to urban areas within countries - in affecting four important drivers of NCDs world-wide: diabetes prevalence, as well as average body mass index (BMI), total cholesterol level and systolic blood pressure. Urbanization is seen by many as a double-edged sword: while its beneficial economic effects are widely acknowledged, it is commonly alleged to produce adverse side effects for NCD-related health outcomes. In this paper we submit this hypothesis to extensive empirical scrutiny, covering a global set of countries from 1980-2008, and applying a range of estimation procedures. Our results indicate that urbanization appears to have contributed to an increase in average BMI and cholesterol levels: the implied difference in average total cholesterol between the most and the least urbanized countries is 0.40mmol/L, while people living in the least urbanized countries are also expected to have an up to 2.3kg/m 2 lower BMI than in the most urbanized ones. Moreover, the least urbanized countries are expected to have an up to 3.2p.p. lower prevalence of diabetes among women. This association is also much stronger in the low and middle-income countries, and is likely to be mediated by energy intake-related variables, such as calorie and fat supply per capita. Copyright © 2017 Elsevier B.V. All rights reserved.

Clustering of Risk Factors for Non-Communicable Diseases among Adolescents from Southern Brazil.

PubMed

Nunes, Heloyse Elaine Gimenes; Gonçalves, Eliane Cristina de Andrade; Vieira, Jéssika Aparecida Jesus; Silva, Diego Augusto Santos

2016-01-01

The aim of this study was to investigate the simultaneous presence of risk factors for non-communicable diseases and the association of these risk factors with demographic and economic factors among adolescents from southern Brazil. The study included 916 students (14-19 years old) enrolled in the 2014 school year at state schools in São José, Santa Catarina, Brazil. Risk factors related to lifestyle (i.e., physical inactivity, excessive alcohol consumption, smoking, sedentary behaviour and unhealthy diet), demographic variables (sex, age and skin colour) and economic variables (school shift and economic level) were assessed through a questionnaire. Simultaneous behaviours were assessed by the ratio between observed and expected prevalences of risk factors for non-communicable diseases. The clustering of risk factors was analysed by multinomial logistic regression. The clusters of risk factors that showed a higher prevalence were analysed by binary logistic regression. The clustering of two, three, four, and five risk factors were found in 22.2%, 49.3%, 21.7% and 3.1% of adolescents, respectively. Subgroups that were more likely to have both behaviours of physical inactivity and unhealthy diet simultaneously were mostly composed of girls (OR = 3.03, 95% CI = 1.57-5.85) and those with lower socioeconomic status (OR = 1.83, 95% CI = 1.05-3.21); simultaneous physical inactivity, excessive alcohol consumption, sedentary behaviour and unhealthy diet were mainly observed among older adolescents (OR = 1.49, 95% CI = 1.05-2.12). Subgroups less likely to have both behaviours of sedentary behaviour and unhealthy diet were mostly composed of girls (OR = 0.58, 95% CI = 0.38-0.89); simultaneous physical inactivity, sedentary behaviour and unhealthy diet were mainly observed among older individuals (OR = 0.66, 95% CI = 0.49-0.87) and those of the night shift (OR = 0.59, 95% CI = 0.43-0.82). Adolescents had a high prevalence of simultaneous risk factors for NCDs. Demographic

A community-based approach to non-communicable chronic disease management within a context of advancing universal health coverage in China: progress and challenges.

PubMed

Xiao, Nanzi; Long, Qian; Tang, Xiaojun; Tang, Shenglan

2014-01-01

Paralleled with the rapid socio-economic development and demographic transition, an epidemic of non-communicable chronic diseases (NCDs) has emerged in China over the past three decades, resulting in increased disease and economic burdens. Over the past decade, with a political commitment of implementing universal health coverage, China has strengthened its primary healthcare system and increased investment in public health interventions. A community-based approach to address NCDs has been acknowledged and recognized as one of the most cost-effective solutions. Community-based strategies include: financial and health administrative support; social mobilization; community health education and promotion; and the use of community health centers in NCD detection, diagnosis, treatment, and patient management. Although China has made good progress in developing and implementing these strategies and policies for NCD prevention and control, many challenges remain. There are a lack of appropriately qualified health professionals at grass-roots health facilities; it is difficult to retain professionals at that level; there is insufficient public funding for NCD care and management; and NCD patients are economically burdened due to limited benefit packages covering NCD treatment offered by health insurance schemes. To tackle these challenges we propose developing appropriate human resource policies to attract greater numbers of qualified health professionals at the primary healthcare level; adjusting the service benefit packages to encourage the use of community-based health services; and increase government investment in public health interventions, as well as investing more on health insurance schemes.

The dynamic of non-communicable disease control policy in Indonesia.

PubMed

Christiani, Yodi; Dugdale, Paul; Tavener, Meredith; Byles, Julie E

2017-05-01

Objective The aim of the present study was to examine non-communicable disease (NCD) policy formation and implementation in Indonesia. Methods Interviews were conducted with 13 Indonesian health policy workers. The processes and issues relating to NCD policy formation were mapped, exploring the interactions between policy makers, technical/implementation bodies, alliances across various levels and the mobilisation of non-policy actors. Results Problems in NCD policy formation include insufficient political interest in NCD control, disconnected policies and difficulty in multisectoral coordination. These problems are well illustrated in relation to tobacco control, but also apply to other control efforts. Nevertheless, participants were optimistic that there are plentiful opportunities for improving NCD control policies given growing global attention to NCD, increases in the national health budget and the growing body of Indonesia-relevant NCD-related research. Conclusion Indonesia's success in the creation and implementation of NCD policy will be dependent on high-level governmental leadership, including support from the President, the Health Minister and coordinating ministries. What is known about the topic? The burden of NCD in Indonesia has increased gradually. Nationally, NCD-related mortality accounted for 65% of deaths in 2010. Indonesia is also a country with the highest burden of tobacco smoking in the world. However, the government has not instituted sufficient policy action to tackle NCDs, including tobacco control. What does this paper add? This paper deepens our understanding of current NCD control policy formation in Indonesia, including the possible underlying reason why Indonesia has weak tobacco control policies. It describes the gaps in the current policies, the actors involved in policy formation, the challenges in policy formation and implementation and potential opportunities for improving NCD control. What are the implications for

The impact of poverty reduction and development interventions on non-communicable diseases and their behavioural risk factors in low and lower-middle income countries: A systematic review

PubMed Central

Pullar, Jessie; Allen, Luke; Townsend, Nick; Williams, Julianne; Foster, Charlie; Roberts, Nia; Rayner, Mike; Mikkelsen, Bente; Branca, Francesco

2018-01-01

Introduction Non-communicable diseases (NCDs) disproportionately affect low- and lower-middle income countries (LLMICs) where 80% of global NCD related deaths occur. LLMICs are the primary focus of interventions to address development and poverty indicators. We aimed to synthesise the evidence of these interventions' impact on the four primary NCDs (cardiovascular disease, diabetes, chronic respiratory disease and cancer) and their common behavioural risk factors (unhealthy diets, physical inactivity, tobacco and alcohol use). Methods We systematically searched four online databases (Medline, Embase, Web of Science and Global Health) for primary research conducted in LLMICS, published between January 1st 1990 and February 15th 2016. Studies involved development or poverty interventions which reported on outcomes relating to NCDs. We extracted summary level data on study design, population, health outcomes and potential confounders. Results From 6383 search results, 29 studies from 24 LLMICs published between 1999 and 2015 met our inclusion criteria. The quality of included studies was limited and heterogeneity of outcome measures required narrative synthesis. One study measured impact on NCD prevalence, one physical activity and 27 dietary components. The majority of papers (23), involved agricultural interventions. Primary outcome measures tended to focus on undernutrition. Intensive agricultural interventions were associated with improved calorie, vitamin, fruit and vegetable intake. However, positive impacts were reliant on participant's land ownership, infection status and limited in generalisability. Just three studies measured adult obesity; two indicated increased income and consequential food affordability had the potential to increase obesity. Overall, there was poor alignment between included studies outcome measures and the key policy options and objectives of the Global Action Plan on NCDs. Conclusions Though many interventions addressing poverty and

The impact of poverty reduction and development interventions on non-communicable diseases and their behavioural risk factors in low and lower-middle income countries: A systematic review.

PubMed

Pullar, Jessie; Allen, Luke; Townsend, Nick; Williams, Julianne; Foster, Charlie; Roberts, Nia; Rayner, Mike; Mikkelsen, Bente; Branca, Francesco; Wickramasinghe, Kremlin

2018-01-01

Non-communicable diseases (NCDs) disproportionately affect low- and lower-middle income countries (LLMICs) where 80% of global NCD related deaths occur. LLMICs are the primary focus of interventions to address development and poverty indicators. We aimed to synthesise the evidence of these interventions' impact on the four primary NCDs (cardiovascular disease, diabetes, chronic respiratory disease and cancer) and their common behavioural risk factors (unhealthy diets, physical inactivity, tobacco and alcohol use). We systematically searched four online databases (Medline, Embase, Web of Science and Global Health) for primary research conducted in LLMICS, published between January 1st 1990 and February 15th 2016. Studies involved development or poverty interventions which reported on outcomes relating to NCDs. We extracted summary level data on study design, population, health outcomes and potential confounders. From 6383 search results, 29 studies from 24 LLMICs published between 1999 and 2015 met our inclusion criteria. The quality of included studies was limited and heterogeneity of outcome measures required narrative synthesis. One study measured impact on NCD prevalence, one physical activity and 27 dietary components. The majority of papers (23), involved agricultural interventions. Primary outcome measures tended to focus on undernutrition. Intensive agricultural interventions were associated with improved calorie, vitamin, fruit and vegetable intake. However, positive impacts were reliant on participant's land ownership, infection status and limited in generalisability. Just three studies measured adult obesity; two indicated increased income and consequential food affordability had the potential to increase obesity. Overall, there was poor alignment between included studies outcome measures and the key policy options and objectives of the Global Action Plan on NCDs. Though many interventions addressing poverty and development have great potential to impact

Non-communicable diseases and preventive health behaviors: a comparison of Hispanics nationally and those living along the US-Mexico border.

PubMed

Reininger, Belinda M; Wang, Jing; Fisher-Hoch, Susan P; Boutte, Alycia; Vatcheva, Kristina; McCormick, Joseph B

2015-06-19

Non-communicable diseases (NCDs) are rising among US Hispanics, but few studies have examined the preventive health behaviors for these NCDs among Hispanics. This study compared the preventive health behaviors of smoke-free living, physical activity, fruit and vegetable consumption, and avoidance of heavy alcohol use in Hispanics in the United States and Hispanics living along the US-Mexico border. Two weighted data sets with information on Hispanic populations were analyzed: 1) the national Behavioral Risk Factor Surveillance Survey (n = 29,942) from 2009; and 2) the Cameron County Hispanic Cohort (n = 1,439) recruited from the US-Mexico border between 2008-2011. To compare the preventive health behaviors of the samples, within a generalized estimating equation framework, weighted univariate and multivariate logistic regression analyses were conducted controlling for age, educational attainment, employment, language, and insurance status. Statistical tests were two-sided with a significance level set at 0.05. Both samples reported low engagement in preventive behaviors. However, Hispanic males and females from the US-Mexico border were significantly less likely than the national sample to meet physical activity and fruit and vegetable consumption guidelines. Also, Hispanic males from the US-Mexico border were more likely to engage in heavy alcohol use. The lack of preventive health behaviors among Hispanics living along the US-Mexico border presents a dire prospect for NCD control in the region. Multipronged approaches to address multiple behaviors should be considered.

[Prevention of Chronic Kidney Disease and strategies to counteract chronic diseases in Italy].

PubMed

Mastrilli, Valeria; D'Elia, Roberto; Galeone, Daniela

2016-01-01

The Prevention of Chronic Kidney Disease (CKD) is placed in the more general context of prevention of major chronic Non Communicable Diseases (NCDs): cardiovascular diseases, diabetes, chronic lung diseases and tumors that are the main problem for public health worldwide. Any health policy strategy aimed to the prevention of NCDs has to provide knowledge of health and socioeconomic status of the population, to reduce the level of exposure to risk factors and to adapt health services to the request for assistance. To this purpose, population monitoring systems have been implemented in the last years. The NCDs share some risk factors that are related, in large part, to unhealthy individual behaviours: smoking, alcohol abuse, unhealthy diet and physical inactivity. NCDs prevention has to be understood as the set of all actions, sanitary and not, aiming to prevent or delay the onset of diseases or their complications. Preventive measures should, therefore, involve not only the health sector but also all the actors that can help to prevent that disease. As for the Prevention of CKD, the Ministry of Health has established a working table, which handled the Drafting of the "Position paper for the CKD", approved in the State-Regions Conference on august 8th 2014. The document draws a national strategy to combat this disease through primary prevention, early diagnosis and the establishment of diagnostic - therapeutic pathways (DTP).

The Prevalence and Determinants of Chronic Non-Communicable Disease Risk Factors amongst Adults in the Dikgale Health Demographic and Surveillance System (HDSS) Site, Limpopo Province of South Africa

PubMed Central

Maimela, Eric; Modjadji, Sewela E. P.; Choma, Solomon S. R.; Dikotope, Sekgothe A.; Ntuli, Thembelihle S.

2016-01-01

Background The aim of the study was to determine the prevalence and determinants of chronic non-communicable disease (NCD) risk factors in a rural community in the Limpopo Province of South Africa. Methods This survey was conducted using the WHO "STEPwise approach to the surveillance of non-communicable diseases" (STEPS) methodology. Participants were residents of the Dikgale HDSS site and standardised international protocols were used to measure behavioural risk factors (smoking, alcohol consumption, fruit and vegetable intake and, physical activity) and physical characteristics (weight, height, waist and hip circumferences and blood pressure–BP). Fasting blood glucose, triglyceride, cholesterol and HDL-C were determined in 732 participants. Data were analysed using STATA 12 for Windows. Results The prevalence of current smokers amongst the participants was 13.7%, of which 81.3% were daily smokers. Alcohol was consumed by 16.3% of the participants. The majority of participants (88.6%) had low daily intake of fruit and vegetables and low physical activity (66.5%). The prevalence of hypertension amongst the participants was 38.2%. Overweight, obesity and high waist circumference were prevalent in females. The cardio-metabolic risk profile was not significantly different between men and women. People who were older than 40 years, overweight or obese and those who consumed alcohol were more likely to be hypertensive. Smoking was associated significantly with older age, males, never married and divorced people. Alcohol consumption was associated with older age, males, low educational status and low income. Conclusion High levels of risk factors for NCDs among adults in the Dikgale HDSS suggest an urgent need for health interventions to control these risk factors at the population level in order to reduce the prevalence of NCDs. PMID:26882033

Prevention of cancer and non-communicable diseases.

PubMed

Cannon, Geoffrey; Gupta, Prakash; Gomes, Fabio; Kerner, Jon; Parra, William; Weiderpass, Elisabete; Kim, Jeongseon; Moore, Malcolm; Sutcliffe, Catherine; Sutcliffe, Simon

2012-01-01

Cancer is a leading cause of death worldwide, accounting for approximately 7.6 million deaths (13% of all deaths) in 2008. Cancer mortality is projected to increase to 11 million deaths in 2030, with the majority occurring in regions of the world with the least capacity to respond. However, cancer is not only a personal, societal and economic burden but also a potential societal opportunity in the context of functional life - the years gained through effective prevention and treatment, and strategies to enhance survivorship. The United Nations General Assembly Special Session in 2011 has served to focus attention on key aspects of cancer prevention and control. Firstly, cancer is largely preventable, by feasible means. Secondly, cancer is one of a number of chronic, non- communicable diseases that share common risk factors whose prevention and control would benefit a majority of the world's population. Thirdly, a proportion of cancers can be attributed to infectious, communicable causal factors (e.g., HPV, HBV, H.pylori, parasites, flukes) and that strategies to control the burden of infectious diseases have relevance to the control of cancer. Fourthly, that the natural history of non-communicable diseases, including cancer, from primary prevention through diagnosis, treatment and care, is underwritten by the impact of social, economic and environmental determinants of health (e.g., poverty, illiteracy, gender inequality, social isolation, stigma, socio-economic status). Session 1 of the 4th International Cancer Control Congress (ICCC-4) focused on the social, economic and environmental, as well as biological and behavioural, modifiers of the risk of cancer through one plenary presentation and four interactive workshop discussions. The workshop sessions concerned 1) the Global Adult Tobacco Survey and social determinants of tobacco use in high burden low- and middle-income countries; 2) the role of diet, including alcohol, and physical activity in modifying the

Adapting HIV patient and program monitoring tools for chronic non-communicable diseases in Ethiopia.

PubMed

Letebo, Mekitew; Shiferaw, Fassil

2016-06-02

Chronic non-communicable diseases (NCDs) have become a huge public health concern in developing countries. Many resource-poor countries facing this growing epidemic, however, lack systems for an organized and comprehensive response to NCDs. Lack of NCD national policy, strategies, treatment guidelines and surveillance and monitoring systems are features of health systems in many developing countries. Successfully responding to the problem requires a number of actions by the countries, including developing context-appropriate chronic care models and programs and standardization of patient and program monitoring tools. In this cross-sectional qualitative study we assessed existing monitoring and evaluation (M&E) tools used for NCD services in Ethiopia. Since HIV care and treatment program is the only large-scale chronic care program in the country, we explored the M&E tools being used in the program and analyzed how these tools might be adapted to support NCD services in the country. Document review and in-depth interviews were the main data collection methods used. The interviews were held with health workers and staff involved in data management purposively selected from four health facilities with high HIV and NCD patient load. Thematic analysis was employed to make sense of the data. Our findings indicate the apparent lack of information systems for NCD services, including the absence of standardized patient and program monitoring tools to support the services. We identified several HIV care and treatment patient and program monitoring tools currently being used to facilitate intake process, enrolment, follow up, cohort monitoring, appointment keeping, analysis and reporting. Analysis of how each tool being used for HIV patient and program monitoring can be adapted for supporting NCD services is presented. Given the similarity between HIV care and treatment and NCD services and the huge investment already made to implement standardized tools for HIV care and

Community health workers for non-communicable diseases prevention and control in developing countries: Evidence and implications.

PubMed

Jeet, Gursimer; Thakur, J S; Prinja, Shankar; Singh, Meenu

2017-01-01

National programs for non-communicable diseases (NCD) prevention and control in different low middle income countries have a strong community component. A community health worker (CHW) delivers NCD preventive services using informational as well as behavioural approaches. Community education and interpersonal communication on lifestyle modifications is imparted with focus on primordial prevention of NCDs and screening is conducted as part of early diagnosis and management. However, the effectiveness of health promotion and screening interventions delivered through community health workers needs to be established. This review synthesised evidence on effectiveness of CHW delivered NCD primary prevention interventions in low and middle-income countries (LMICs). A systematic review of trials that utilised community health workers for primary prevention/ early detection strategy in the management of NCDs (Diabetes, cardiovascular diseases (CVD), cancers, stroke, Chronic Obstructive Pulmonary Diseases (COPD)) in LMICs was conducted. Digital databases like PubMed, EMBASE, OVID, Cochrane library, dissertation abstracts, clinical trials registry web sites of different LMIC were searched for such publications between years 2000 and 2015. We focussed on community based randomised controlled trial and cluster randomised trials without any publication language limitation. The primary outcome of review was percentage change in population with different behavioural risk factors. Additionally, mean overall changes in levels of several physical or biochemical parameters were studied as secondary outcomes. Subgroup analyses was performed by the age and sex of participants, and sensitivity analyses was conducted to assess the robustness of the findings. Sixteen trials meeting the inclusion criteria were included in the review. Duration, study populations and content of interventions varied across trials. The duration of the studies ranged from mean follow up of 4 months for some risk

Towards a comprehensive global approach to prevention and control of NCDs.

PubMed

McKee, Martin; Haines, Andy; Ebrahim, Shah; Lamptey, Peter; Barreto, Mauricio L; Matheson, Don; Walls, Helen L; Foliaki, Sunia; Miranda, J Jaime; Chimeddamba, Oyun; Garcia-Marcos, Luis; Vineis, Paolo; Pearce, Neil

2014-10-28

The "25×25" strategy to tackle the global challenge of non-communicable diseases takes a traditional approach, concentrating on a few diseases and their immediate risk factors. We propose elements of a comprehensive strategy to address NCDs that takes account of the evolving social, economic, environmental and health care contexts, while developing mechanisms to respond effectively to local patterns of disease. Principles that underpin the comprehensive strategy include: (a) a balance between measures that address health at the individual and population level; (b) the need to identify evidence-based feasible and effective approaches tailored to low and middle income countries rather than exporting questionable strategies developed in high income countries; (c) developing primary health care as a universal framework to support prevention and treatment; (d) ensuring the ability to respond in real time to the complex adaptive behaviours of the global food, tobacco, alcohol and transport industries; (e) integrating evidence-based, cost-effective, and affordable approaches within the post-2015 sustainable development agenda; (f) determination of a set of priorities based on the NCD burden within each country, taking account of what it can afford, including the level of available development assistance; and (g) change from a universal "one-size fits all" approach of relatively simple prevention oriented approaches to more comprehensive multi-sectoral and development-oriented approaches which address both health systems and the determinants of NCD risk factors. The 25×25 is approach is absolutely necessary but insufficient to tackle the the NCD disease burden of mortality and morbidity. A more comprehensive approach is recommended.

[Chronic non-communicable diseases in Brazil: priorities for disease management and research].

PubMed

Duncan, Bruce Bartholow; Chor, Dóra; Aquino, Estela M L; Bensenor, Isabela M; Mill, José Geraldo; Schmidt, Maria Inês; Lotufo, Paulo Andrade; Vigo, Alvaro; Barreto, Sandhi Maria

2012-12-01

Chronic Non-Communicable Diseases are the main source of disease burden in Brazil. In 2011, the Brazilian Ministry of Health launched the Strategic Plan of Action for Management of Chronic Non-Communicable Diseases focusing on population-based interventions to manage cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases mainly through fighting tobacco use, unhealthy diets, physical inactivity and the harmful use of alcohol. Although a significant number of scientific studies on chronic diseases and their risk factors have been undertaken in Brazil, few are of cohort design. In this context, the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort study of 15,105 Brazilian public servants reflects the reality of high prevalences of diabetes, hypertension and the main chronic diseases risk factors. The diversity of information that the Study will produce can provide important input to better understand the causes of chronic diseases and to support public policies for fighting them.

Clustering of Risk Factors for Non-Communicable Diseases among Adolescents from Southern Brazil

PubMed Central

2016-01-01

Introduction The aim of this study was to investigate the simultaneous presence of risk factors for non-communicable diseases and the association of these risk factors with demographic and economic factors among adolescents from southern Brazil. Methods The study included 916 students (14–19 years old) enrolled in the 2014 school year at state schools in São José, Santa Catarina, Brazil. Risk factors related to lifestyle (i.e., physical inactivity, excessive alcohol consumption, smoking, sedentary behaviour and unhealthy diet), demographic variables (sex, age and skin colour) and economic variables (school shift and economic level) were assessed through a questionnaire. Simultaneous behaviours were assessed by the ratio between observed and expected prevalences of risk factors for non-communicable diseases. The clustering of risk factors was analysed by multinomial logistic regression. The clusters of risk factors that showed a higher prevalence were analysed by binary logistic regression. Results The clustering of two, three, four, and five risk factors were found in 22.2%, 49.3%, 21.7% and 3.1% of adolescents, respectively. Subgroups that were more likely to have both behaviours of physical inactivity and unhealthy diet simultaneously were mostly composed of girls (OR = 3.03, 95% CI = 1.57–5.85) and those with lower socioeconomic status (OR = 1.83, 95% CI = 1.05–3.21); simultaneous physical inactivity, excessive alcohol consumption, sedentary behaviour and unhealthy diet were mainly observed among older adolescents (OR = 1.49, 95% CI = 1.05–2.12). Subgroups less likely to have both behaviours of sedentary behaviour and unhealthy diet were mostly composed of girls (OR = 0.58, 95% CI = 0.38–0.89); simultaneous physical inactivity, sedentary behaviour and unhealthy diet were mainly observed among older individuals (OR = 0.66, 95% CI = 0.49–0.87) and those of the night shift (OR = 0.59, 95% CI = 0.43–0.82). Conclusion Adolescents had a high prevalence

Prevalence of risk factors for non-communicable diseases in rural & urban Tamil Nadu

PubMed Central

Oommen, Anu Mary; Abraham, Vinod Joseph; George, Kuryan; Jose, V. Jacob

2016-01-01

Background & objectives: Surveillance of risk factors is important to plan suitable control measures for non-communicable diseases (NCDs). The objective of this study was to assess the behavioural, physical and biochemical risk factors for NCDs in Vellore Corporation and Kaniyambadi, a rural block in Vellore district, Tamil Nadu, India. Methods: This cross-sectional study was carried out among 6196 adults aged 30-64 yr, with 3799 participants from rural and 2397 from urban areas. The World Health Organization-STEPS method was used to record behavioural risk factors, anthropometry, blood pressure, fasting blood glucose and lipid profile. Multiple logistic regression was used to assess associations between risk factors. Results: The proportion of tobacco users (current smoking or daily use of smokeless tobacco) was 23 per cent in the rural sample and 18 per cent in the urban, with rates of smoking being similar. Ever consumption of alcohol was 62 per cent among rural men and 42 per cent among urban men. Low physical activity was seen among 63 per cent of the urban and 43 per cent of the rural sample. Consumption of fruits and vegetables was equally poor in both. In the urban sample, 54 per cent were overweight, 29 per cent had hypertension and 24 per cent diabetes as compared to 31, 17 and 11 per cent, respectively, in the rural sample. Physical inactivity was associated with hypertension, body mass index (BMI) ≥25 kg/m2, central obesity and dyslipidaemia after adjusting for other factors. Increasing age, male sex, BMI ≥25 kg/m2 and central obesity were independently associated with both hypertension and diabetes. Interpretation & conclusions: Diabetes, hypertension, dyslipidaemia, physical inactivity and overweight were higher in the urban area as compared to the rural area which had higher rates of smokeless tobacco use and alcohol consumption. Smoking and inadequate consumption of fruits and vegetables were equally prevalent in both the urban and rural samples

Union for International Cancer Control International Session: healthcare economics: the significance of the UN Summit non-communicable diseases political declaration in Asia.

PubMed

Akaza, Hideyuki; Kawahara, Norie; Masui, Tohru; Takeyama, Kunihiko; Nogimori, Masafumi; Roh, Jae Kyung

2013-06-01

The Japan National Committee for the Union for International Cancer Control (UICC) and UICC-Asia Regional Office (ARO) organized an international session as part of the official program of the 71st Annual Meeting of the Japanese Cancer Association to discuss the topic "Healthcare Economics: The Significance of the UN Summit non-communicable diseases (NCDs) Political Declaration in Asia." The presenters and participants discussed the growing cost of cancer in the Asian region and the challenges that are faced by the countries of Asia, all of which face budgetary and other systemic constraints in tackling and controlling cancer in the region. The session benefited from the participation of various stakeholders, including cancer researchers and representatives of the pharmaceutical industry. They discussed the significance of the UN Political Declaration on the prevention and control of NCDs (2011) as a means of boosting awareness of cancer in the Asian region and also addressed the ways in which stakeholders can cooperate to improve cancer control and treatment. Other issues that were covered included challenges relating to pharmaceutical trials in Asia and how to link knowledge and research outcomes. The session concluded with the recognition that with the onset of a super-aged society in most countries in Asia and an increasing focus on quality of life rather than quantity of life, it is more important than ever for all stakeholders to continue to share information and promote policy dialogue on cancer control and treatment. © 2013 Japanese Cancer Association.

Food Exchange List and Dietary Management of Non-Communicable Diseases in Cultural Perspective.

PubMed

Khan, Mahnaz Nasir; Kalsoom, Samia; Khan, Ayyaz Ali

2017-01-01

This review focuses at highlighting the importance of Food Exchange List in cultural perspective, as an effective dietary tool to help individuals' manage their dietary modifications in relation to non communicable diseases whilst specifying measures that can help improve the quality of Food Exchange Lists for combating various non communicable diseases and addressing adherence related issues to specialized diets. A search was done using PubMed & Google Scholar till June 2016. Search terms used were food exchange list AND disease, diet AND non-communicable diseases. We included only studies that discussed Food Exchange List (FEL) in relation to non-communicable diseases; in addition to factors like cultural relevance and adherence. Out of the 837 papers accessed 57 were identified as relevant to the Food Exchange List, out of which 39 papers were focused to the concept and development of the Food Exchange List. Only 18 discussed FEL in relation to non communicable diseases and were thus included in the review. Food exchange list is a user friendly tool for dietary modification due to disease. This tool may help to customize meals for people as it provides information regarding various food items in different groups. This tool is helpful in reducing blood & plasma glucose levels, maintaining lipid profile & effectively combating other diet related diseases & those ailments in which diet plays a significant role in maintenance & prevention from reoccurrences. However, better management and adherence to modified diets for non communicable diseases can be ensured by keeping cultural relevance under consideration before using Food Exchange Lists for such diseases.

Towards global benchmarking of food environments and policies to reduce obesity and diet-related non-communicable diseases: design and methods for nation-wide surveys

PubMed Central

Vandevijvere, Stefanie; Swinburn, Boyd

2014-01-01

Introduction Unhealthy diets are heavily driven by unhealthy food environments. The International Network for Food and Obesity/non-communicable diseases (NCDs) Research, Monitoring and Action Support (INFORMAS) has been established to reduce obesity, NCDs and their related inequalities globally. This paper describes the design and methods of the first-ever, comprehensive national survey on the healthiness of food environments and the public and private sector policies influencing them, as a first step towards global monitoring of food environments and policies. Methods and analysis A package of 11 substudies has been identified: (1) food composition, labelling and promotion on food packages; (2) food prices, shelf space and placement of foods in different outlets (mainly supermarkets); (3) food provision in schools/early childhood education (ECE) services and outdoor food promotion around schools/ECE services; (4) density of and proximity to food outlets in communities; food promotion to children via (5) television, (6) magazines, (7) sport club sponsorships, and (8) internet and social media; (9) analysis of the impact of trade and investment agreements on food environments; (10) government policies and actions; and (11) private sector actions and practices. For the substudies on food prices, provision, promotion and retail, ‘environmental equity’ indicators have been developed to check progress towards reducing diet-related health inequalities. Indicators for these modules will be assessed by tertiles of area deprivation index or school deciles. International ‘best practice benchmarks’ will be identified, against which to compare progress of countries on improving the healthiness of their food environments and policies. Dissemination This research is highly original due to the very ‘upstream’ approach being taken and its direct policy relevance. The detailed protocols will be offered to and adapted for countries of varying size and income in order to

Prevalence and Knowledge Assessment of HIV and Non-Communicable Disease Risk Factors among Formal Sector Employees in Namibia.

PubMed

Guariguata, Leonor; de Beer, Ingrid; Hough, Rina; Mulongeni, Pancho; Feeley, Frank G; Rinke de Wit, Tobias F

2015-01-01

The burden of non-communicable diseases (NCDs) is growing in sub-Saharan Africa combined with an already high prevalence of infectious disease, like HIV. Engaging the formal employment sector may present a viable strategy for addressing both HIV and NCDs in people of working age. This study assesses the presence of three of the most significant threats to health in Namibia among employees in the formal sector: elevated blood pressure, elevated blood glucose, and HIV and assesses the knowledge and self-perceived risk of employees for these conditions. A health and wellness screening survey of employees working in 13 industries in the formal sector of Namibia was conducted including 11,192 participants in the Bophelo! Project in Namibia, from January 2009 to October 2010. The survey combined a medical screening for HIV, blood glucose and blood pressure with an employee-completed survey on knowledge and risk behaviors for those conditions. We estimated the prevalence of the three conditions and compared to self-reported employee knowledge and risk behaviors and possible determinants. 25.8% of participants had elevated blood pressure, 8.3% of participants had an elevated random blood glucose measurement, and 8.9% of participants tested positive for HIV. Most participants were not smokers (80%), reported not drinking alcohol regularly (81.2%), and had regular condom use (66%). Most participants could not correctly identify risk factors for hypertension (57.2%), diabetes (57.3%), or high-risk behaviors for HIV infection (59.5%). In multivariate analysis, having insurance (OR:1.15, 95%CI: 1.03 - 1.28) and a managerial position (OR: 1.29, 95%CI: 1.13 - 1.47) were associated with better odds of knowledge of diabetes. The prevalence of elevated blood pressure, elevated blood glucose, and HIV among employees of the Namibian formal sector is high, while risk awareness is low. Attention must be paid to improving the knowledge of health-related risk factors as well as providing

Supermarket purchase contributes to nutrition-related non-communicable diseases in urban Kenya.

PubMed

Demmler, Kathrin M; Klasen, Stephan; Nzuma, Jonathan M; Qaim, Matin

2017-01-01

While undernutrition and related infectious diseases are still pervasive in many developing countries, the prevalence of non-communicable diseases (NCD), typically associated with high body mass index (BMI), is rapidly rising. The fast spread of supermarkets and related shifts in diets were identified as possible factors contributing to overweight and obesity in developing countries. Potential effects of supermarkets on people's health have not been analyzed up till now. This study investigates the effects of purchasing food in supermarkets on people's BMI, as well as on health indicators such as fasting blood glucose (FBG), blood pressure (BP), and the metabolic syndrome. This study uses cross-section observational data from urban Kenya. Demographic, anthropometric, and bio-medical data were collected from 550 randomly selected adults. Purchasing food in supermarkets is defined as a binary variable that takes a value of one if any food was purchased in supermarkets during the last 30 days. In a robustness check, the share of food purchased in supermarkets is defined as a continuous variable. Instrumental variable regressions are applied to control for confounding factors and establish causality. Purchasing food in supermarkets contributes to higher BMI (+ 1.8 kg/m2) (P<0.01) and an increased probability (+ 20 percentage points) of being overweight or obese (P<0.01). Purchasing food in supermarkets also contributes to higher levels of FBG (+ 0.3 mmol/L) (P<0.01) and a higher likelihood (+ 16 percentage points) of suffering from pre-diabetes (P<0.01) and the metabolic syndrome (+ 7 percentage points) (P<0.01). Effects on BP could not be observed. Supermarkets and their food sales strategies seem to have direct effects on people's health. In addition to increasing overweight and obesity, supermarkets contribute to nutrition-related NCDs. Effects of supermarkets on nutrition and health can mainly be ascribed to changes in the composition of people's food choices.

Nutrition transition in South Asia: the emergence of non-communicable chronic diseases

PubMed Central

Bishwajit, Ghose

2015-01-01

Overview: South Asian countries have experienced a remarkable economic growth during last two decades along with subsequent transformation in social, economic and food systems. Rising disposable income levels continue to drive the nutrition transition characterized by a shift from a traditional high-carbohydrate, low-fat diets towards diets with a lower carbohydrate and higher proportion of saturated fat, sugar and salt. Steered by various transitions in demographic, economic and nutritional terms, South Asian population are experiencing a rapidly changing disease profile. While the healthcare systems have long been striving to disentangle from the vicious cycle of poverty and undernutrition, South Asian countries are now confronted with an emerging epidemic of obesity and a constellation of other non-communicable diseases (NCDs). This dual burden is bringing about a serious health and economic conundrum and is generating enormous pressure on the already overstretched healthcare system of South Asian countries. Objectives: The Nutrition transition has been a very popular topic in the field of human nutrition during last few decades and many countries and broad geographic regions have been studied. However there is no review on this topic in the context of South Asia  as yet. The main purpose of this review is to highlight the factors accounting for the onset of nutrition transition and its subsequent impact on epidemiological transition in five major South Asian countries including Bangladesh, India, Nepal, Pakistan and Sri Lanka. Special emphasis was given on India and Bangladesh as they together account for 94% of the regional population and about half world’s malnourished population. Methods: This study is literature based. Main data sources were published research articles obtained through an electronic medical databases search. PMID:26834976

Non-communicable diseases and HIV care and treatment: models of integrated service delivery.

PubMed

Duffy, Malia; Ojikutu, Bisola; Andrian, Soa; Sohng, Elaine; Minior, Thomas; Hirschhorn, Lisa R

2017-08-01

Non-communicable diseases (NCD) are a growing cause of morbidity in low-income countries including in people living with human immunodeficiency virus (HIV). Integration of NCD and HIV services can build upon experience with chronic care models from HIV programmes. We describe models of NCD and HIV integration, challenges and lessons learned. A literature review of published articles on integrated NCD and HIV programs in low-income countries and key informant interviews were conducted with leaders of identified integrated NCD and HIV programs. Information was synthesised to identify models of NCD and HIV service delivery integration. Three models of integration were identified as follows: NCD services integrated into centres originally providing HIV care; HIV care integrated into primary health care (PHC) already offering NCD services; and simultaneous introduction of integrated HIV and NCD services. Major challenges identified included NCD supply chain, human resources, referral systems, patient education, stigma, patient records and monitoring and evaluation. The range of HIV and NCD services varied widely within and across models. Regardless of model of integration, leveraging experience from HIV care models and adapting existing systems and tools is a feasible method to provide efficient care and treatment for the growing numbers of patients with NCDs. Operational research should be conducted to further study how successful models of HIV and NCD integration can be expanded in scope and scaled-up by managers and policymakers seeking to address all the chronic care needs of their patients. © 2017 John Wiley & Sons Ltd.

Community health workers for non-communicable diseases prevention and control in developing countries: Evidence and implications

PubMed Central

Jeet, Gursimer; Thakur, J. S.; Prinja, Shankar; Singh, Meenu

2017-01-01

Background National programs for non-communicable diseases (NCD) prevention and control in different low middle income countries have a strong community component. A community health worker (CHW) delivers NCD preventive services using informational as well as behavioural approaches. Community education and interpersonal communication on lifestyle modifications is imparted with focus on primordial prevention of NCDs and screening is conducted as part of early diagnosis and management. However, the effectiveness of health promotion and screening interventions delivered through community health workers needs to be established. Objective This review synthesised evidence on effectiveness of CHW delivered NCD primary prevention interventions in low and middle-income countries (LMICs). Methods A systematic review of trials that utilised community health workers for primary prevention/ early detection strategy in the management of NCDs (Diabetes, cardiovascular diseases (CVD), cancers, stroke, Chronic Obstructive Pulmonary Diseases (COPD)) in LMICs was conducted. Digital databases like PubMed, EMBASE, OVID, Cochrane library, dissertation abstracts, clinical trials registry web sites of different LMIC were searched for such publications between years 2000 and 2015. We focussed on community based randomised controlled trial and cluster randomised trials without any publication language limitation. The primary outcome of review was percentage change in population with different behavioural risk factors. Additionally, mean overall changes in levels of several physical or biochemical parameters were studied as secondary outcomes. Subgroup analyses was performed by the age and sex of participants, and sensitivity analyses was conducted to assess the robustness of the findings. Results Sixteen trials meeting the inclusion criteria were included in the review. Duration, study populations and content of interventions varied across trials. The duration of the studies ranged from

Rising Health Expenditure Due to Non-Communicable Diseases in India: An Outlook.

PubMed

Barik, Debasis; Arokiasamy, Perianayagam

2016-01-01

With ongoing demographic transition, epidemiological transition has been emerged as a growing concern in India. The share of non-communicable disease in total disease burden has increased from 31% in 1990 to 45% in 2010. This paper seeks to explore the health scenario of India in the wake of the growing pace of non-communicable diseases such as diabetes and hypertension among Indian population using data from health and morbidity survey of the National Sample Survey Organisation (2004) and notifies about the resource needed to tackle this growing health risk. Given the share of private players (70%) in Indian health system, results indicate a higher private expenditure, mostly out-of-pocket expense, on account of non-communicable diseases. A timely look into the matter may tackle a more dreadful situation in near future.

Rising Health Expenditure Due to Non-Communicable Diseases in India: An Outlook

PubMed Central

Barik, Debasis; Arokiasamy, Perianayagam

2016-01-01

With ongoing demographic transition, epidemiological transition has been emerged as a growing concern in India. The share of non-communicable disease in total disease burden has increased from 31% in 1990 to 45% in 2010. This paper seeks to explore the health scenario of India in the wake of the growing pace of non-communicable diseases such as diabetes and hypertension among Indian population using data from health and morbidity survey of the National Sample Survey Organisation (2004) and notifies about the resource needed to tackle this growing health risk. Given the share of private players (70%) in Indian health system, results indicate a higher private expenditure, mostly out-of-pocket expense, on account of non-communicable diseases. A timely look into the matter may tackle a more dreadful situation in near future. PMID:27965952

The capacity-load model of non-communicable disease risk: understanding the effects of child malnutrition, ethnicity and the social determinants of health.

PubMed

Wells, Jonathan C K

2018-05-01

The capacity-load model is a conceptual model developed to improve understanding of the life-course aetiology of non-communicable diseases (NCDs) and their ecological and societal risk factors. The model addresses continuous associations of both (a) nutrition and growth patterns in early life and (b) lifestyle factors at older ages with NCD risk. Metabolic capacity refers to physiological traits strongly contingent on early nutrition and growth during the first 1000 days, which promote the long-term capacity for homeostasis in the context of fuel metabolism and cardiovascular health. Metabolic load refers to components of nutritional status and lifestyle that challenge homeostasis. The higher the load, and the lower the capacity, the greater the NCD risk. The model therefore helps understand dose-response associations of both early development and later phenotype with NCD risk. Infancy represents a critical developmental period, during which slow growth can constrain metabolic capacity, whereas rapid weight gain may elevate metabolic load. Severe acute malnutrition in early childhood (stunting, wasting) may continue to deplete metabolic capacity, and confer elevated susceptibility to NCDs in the long term. The model can be applied to associations of NCD risk with socio-economic position (SEP): lower SEP is generally associated with lower capacity but often also with elevated load. The model can also help explain ethnic differences in NCD risk, as both early growth patterns and later body composition differ systematically between ethnic groups. Recent work has begun to clarify the role of organ development in metabolic capacity, which may further contribute to ethnic differences in NCD risk.

Effective components of exercise and physical activity-related behaviour-change interventions for chronic non-communicable diseases in Africa: protocol for a systematic mixed studies review with meta-analysis

PubMed Central

Igwesi-Chidobe, Chinonso N; Godfrey, Emma L; Kengne, Andre P

2015-01-01

Introduction Chronic non-communicable diseases (NCDs) account for a high burden of mortality and morbidity in Africa. Evidence-based clinical guidelines recommend exercise training and promotion of physical activity behaviour changes to control NCDs. Developing such interventions in Africa requires an understanding of the essential components that make them effective in this context. This is a protocol for a systematic mixed studies review that aims to determine the effective components of exercise and physical activity-related behaviour-change interventions for chronic diseases in Africa, by combining quantitative and qualitative research evidence from studies published until July 2015. Methods and analysis We will conduct a detailed search to identify all published and unpublished studies that assessed the effects of exercise and physical activity-related interventions or the experiences/perspectives of patients to these interventions for NCDs from bibliographic databases and the grey literature. Bibliographic databases include MEDLINE, EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), PsycINFO, CINAHL and Web of Science. We will include the following African regional databases: African Index Medicus (AIM) and AFROLIB, which is the WHO's regional office database for Africa. The databases will be searched from inception until 18 July 2015. Appraisal of study quality will be performed after results synthesis. Data synthesis will be performed independently for quantitative and qualitative data using a mixed methods sequential explanatory synthesis for systematic mixed studies reviews. Meta-analysis will be conducted for the quantitative studies, and thematic synthesis for qualitative studies and qualitative results from the non-controlled observational studies. The primary outcome will include exercise adherence and physical activity behaviour changes. This review protocol is reported according to Preferred Reporting Items for Systematic reviews and

Tuberculosis non-communicable disease comorbidity and multimorbidity in public primary care patients in South Africa.

PubMed

Peltzer, Karl

2018-04-11

 Little is known about the prevalence of non-communicable disease (NCD) multimorbidity among tuberculosis (TB) patients in Africa.Aim and setting: The aim of this study was to assess the prevalence of NCD multimorbidity, its pattern and impact on adverse health outcomes among patients with TB in public primary care in three selected districts of South Africa.  In a cross-sectional survey, new TB and TB retreatment patients were interviewed, and medical records assessed in consecutive sampling within 1 month of anti-TB treatment. The sample included 4207 (54.5% men and 45.5% women) TB patients from 42 primary care clinics in three districts. Multimorbidity was measured as the simultaneous presence of two or more of 10 chronic conditions, including myocardial infarction or angina pectoris, arthritis, asthma, chronic lung disease, diabetes mellitus, hypertension, dyslipidaemia, malignant neoplasms, tobacco and alcohol-use disorder.  The prevalence of comorbidity (with one NCD) was 26.9% and multimorbidity (with two or more NCDs) was 25.3%. We identified three patterns of multimorbidity: (1) cardio-metabolic disorders; (2) respiratory disorders, arthritis and cancer; and (3) substance-use disorders. The likelihood of multimorbidity was higher in older age, among men, and was lower in those with higher education and socio-economic status. The prevalence of physical health decreased, and common mental disorders and post-traumatic stress disorder increased with an increase in the number of chronic conditions.  High NCD comorbidity and multimorbidity were found among TB patients predicted by socio-economic disparity.

How effective are strategies for non-communicable disease prevention and control in a high risk population in a developing country? Isfahan Healthy Heart Programme

PubMed Central

Baghaei, Abdolmehdi; Rabiei, Katayoun; Gharipour, Mojgan; Tavasoli, Ali Akbar; Shirani, Shahin; Bahonar, Ahamad; Davarpanah, Amir Hossein; Ramezani, Mohammad Arash; Kelishadi, Roya

2010-01-01

Introduction The Isfahan Healthy Heart Programme (IHHP) is a community-based programme for non-communicable diseases prevention and control using both a population and high risk approach in Iran. This study demonstrated the efficacy of IHHP interventional strategies to improve lifestyle behaviours in a population at risk for developing cardiovascular diseases. Material and methods Healthy Lifestyle for NCDs High Risk Population is one of ten projects of IHHP. High risk individuals were defined as those who have at least one risk factor for developing coronary artery disease (CAD). Changes of behavioural indicators have been compared between two areas with a survey after 5 years of intervention. Results Among high risk individuals in the intervention and reference areas, 77.8% and 82.5% had at least one major risk factor for CAD. The prevalence of major risk factors for CAD (except cigarette smoking) was decreased in both intervention and reference areas during 5 years of intervention and the pattern of diet and physical activity was improved. Conclusions Interventional activities in IHHP targeting the high risk population seem to be effective in improving lifestyle behaviour, increasing awareness and control of risk factors of the high risk population. PMID:22371716

Mortality due to noncommunicable diseases in Brazil, 1990 to 2015, according to estimates from the Global Burden of Disease study.

PubMed

Malta, Deborah Carvalho; França, Elisabeth; Abreu, Daisy Maria Xavier; Perillo, Rosângela Durso; Salmen, Maíra Coube; Teixeira, Renato Azeredo; Passos, Valeria; Souza, Maria de Fátima Marinho; Mooney, Meghan; Naghavi, Mohsen

2017-01-01

Noncommunicable diseases (NCDs) are the leading health problem globally and generate high numbers of premature deaths and loss of quality of life. The aim here was to describe the major groups of causes of death due to NCDs and the ranking of the leading causes of premature death between 1990 and 2015, according to the Global Burden of Disease (GBD) 2015 study estimates for Brazil. Cross-sectional study covering Brazil and its 27 federal states. This was a descriptive study on rates of mortality due to NCDs, with corrections for garbage codes and underreporting of deaths. This study shows the epidemiological transition in Brazil between 1990 and 2015, with increasing proportional mortality due to NCDs, followed by violence, and decreasing mortality due to communicable, maternal and neonatal causes within the global burden of diseases. NCDs had the highest mortality rates over the whole period, but with reductions in cardiovascular diseases, chronic respiratory diseases and cancer. Diabetes increased over this period. NCDs were the leading causes of premature death (30 to 69 years): ischemic heart diseases and cerebrovascular diseases, followed by interpersonal violence, traffic injuries and HIV/AIDS. The decline in mortality due to NCDs confirms that improvements in disease control have been achieved in Brazil. Nonetheless, the high mortality due to violence is a warning sign. Through maintaining the current decline in NCDs, Brazil should meet the target of 25% reduction proposed by the World Health Organization by 2025.

Capacity building of AYUSH practitioners to study the feasibility of their involvement in non-communicable disease prevention and control

PubMed Central

Kumar, Dinesh; Raina, Sunil Kumar; Bhardwaj, A. K.; Chander, Vishav

2012-01-01

Background: Sharing of public health knowledge and skills by professionals in allopathic system of medicine with Ayurveda, Yoga, and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) professionals in India has always been considered as part of integrating the health system in India. But till date, a curriculum has not been framed for follow-up. Materials and Methods: A training course was developed for AYUSH professionals in India on the public health principles for the prevention and control of non-communicable diseases (NCDs). Three course chairs interacted with international and national public health and AYUSH experts, and the curriculum for a 3-month course was developed. Results: The curriculum comprised interactive lectures, problem-based exercise, field visits, and research protocol development. A total of four participants, nominated by the World Health Organization, India, were trained during the course, with significant (P = 0.00) improvement in knowledge from 53.2 to 80.0 points. Conclusion: A novel and feasible public health course for complementary and alternative medicine professionals on the public health principles for NCDs’ prevention and control is needed to bridge the demand gap for public health professionals in India. PMID:24167339

Towards global benchmarking of food environments and policies to reduce obesity and diet-related non-communicable diseases: design and methods for nation-wide surveys.

PubMed

Vandevijvere, Stefanie; Swinburn, Boyd

2014-05-15

Unhealthy diets are heavily driven by unhealthy food environments. The International Network for Food and Obesity/non-communicable diseases (NCDs) Research, Monitoring and Action Support (INFORMAS) has been established to reduce obesity, NCDs and their related inequalities globally. This paper describes the design and methods of the first-ever, comprehensive national survey on the healthiness of food environments and the public and private sector policies influencing them, as a first step towards global monitoring of food environments and policies. A package of 11 substudies has been identified: (1) food composition, labelling and promotion on food packages; (2) food prices, shelf space and placement of foods in different outlets (mainly supermarkets); (3) food provision in schools/early childhood education (ECE) services and outdoor food promotion around schools/ECE services; (4) density of and proximity to food outlets in communities; food promotion to children via (5) television, (6) magazines, (7) sport club sponsorships, and (8) internet and social media; (9) analysis of the impact of trade and investment agreements on food environments; (10) government policies and actions; and (11) private sector actions and practices. For the substudies on food prices, provision, promotion and retail, 'environmental equity' indicators have been developed to check progress towards reducing diet-related health inequalities. Indicators for these modules will be assessed by tertiles of area deprivation index or school deciles. International 'best practice benchmarks' will be identified, against which to compare progress of countries on improving the healthiness of their food environments and policies. This research is highly original due to the very 'upstream' approach being taken and its direct policy relevance. The detailed protocols will be offered to and adapted for countries of varying size and income in order to establish INFORMAS globally as a new monitoring initiative

Prevalence and Knowledge Assessment of HIV and Non-Communicable Disease Risk Factors among Formal Sector Employees in Namibia

PubMed Central

Guariguata, Leonor; de Beer, Ingrid; Hough, Rina; Mulongeni, Pancho; Feeley, Frank G.; Rinke de Wit, Tobias F.

2015-01-01

Introduction The burden of non-communicable diseases (NCDs) is growing in sub-Saharan Africa combined with an already high prevalence of infectious disease, like HIV. Engaging the formal employment sector may present a viable strategy for addressing both HIV and NCDs in people of working age. This study assesses the presence of three of the most significant threats to health in Namibia among employees in the formal sector: elevated blood pressure, elevated blood glucose, and HIV and assesses the knowledge and self-perceived risk of employees for these conditions. Methods A health and wellness screening survey of employees working in 13 industries in the formal sector of Namibia was conducted including 11,192 participants in the Bophelo! Project in Namibia, from January 2009 to October 2010. The survey combined a medical screening for HIV, blood glucose and blood pressure with an employee-completed survey on knowledge and risk behaviors for those conditions. We estimated the prevalence of the three conditions and compared to self-reported employee knowledge and risk behaviors and possible determinants. Results 25.8% of participants had elevated blood pressure, 8.3% of participants had an elevated random blood glucose measurement, and 8.9% of participants tested positive for HIV. Most participants were not smokers (80%), reported not drinking alcohol regularly (81.2%), and had regular condom use (66%). Most participants could not correctly identify risk factors for hypertension (57.2%), diabetes (57.3%), or high-risk behaviors for HIV infection (59.5%). In multivariate analysis, having insurance (OR:1.15, 95%CI: 1.03 – 1.28) and a managerial position (OR: 1.29, 95%CI: 1.13 – 1.47) were associated with better odds of knowledge of diabetes. Conclusion The prevalence of elevated blood pressure, elevated blood glucose, and HIV among employees of the Namibian formal sector is high, while risk awareness is low. Attention must be paid to improving the knowledge of

Developmental Programming of Adult Disease: Reprogramming by Melatonin?

PubMed

Tain, You-Lin; Huang, Li-Tung; Hsu, Chien-Ning

2017-02-16

Adult-onset chronic non-communicable diseases (NCDs) can originate from early life through so-called the "developmental origins of health and disease" (DOHaD) or "developmental programming". The DOHaD concept offers the "reprogramming" strategy to shift the treatment from adulthood to early life, before clinical disease is apparent. Melatonin, an endogenous indoleamine produced by the pineal gland, has pleiotropic bioactivities those are beneficial in a variety of human diseases. Emerging evidence support that melatonin is closely inter-related to other proposed mechanisms contributing to the developmental programming of a variety of chronic NCDs. Recent animal studies have begun to unravel the multifunctional roles of melatonin in many experimental models of developmental programming. Even though some progress has been made in research on melatonin as a reprogramming strategy to prevent DOHaD-related NCDs, future human studies should aim at filling the translational gap between animal models and clinical trials. Here, we review several key themes on the reprogramming effects of melatonin in DOHaD research. We have particularly focused on the following areas: mechanisms of developmental programming; the interrelationship between melatonin and mechanisms underlying developmental programming; pathophysiological roles of melatonin in pregnancy and fetal development; and insight provided by animal models to support melatonin as a reprogramming therapy. Rates of NCDs are increasing faster than anticipated all over the world. Hence, there is an urgent need to understand reprogramming mechanisms of melatonin and to translate experimental research into clinical practice for halting a growing list of DOHaD-related NCDs.

Urban-rural differences in the prevalence of non-communicable diseases risk factors among 25-74 years old citizens in Yangon Region, Myanmar: a cross sectional study.

PubMed

Htet, Aung Soe; Bjertness, Marius B; Sherpa, Lhamo Y; Kjøllesdal, Marte Karoline; Oo, Win Myint; Meyer, Haakon E; Stigum, Hein; Bjertness, Espen

2016-12-05

Recent societal and political reforms in Myanmar may upturn the socio-economy and, thus, contribute to the country's health transition. Baseline data on urban-rural disparities in non-communicable disease (NCD) risk factors are not thoroughly described in this country which has been relatively closed for more than five decades. We aim to investigate urban-rural differences in mean values and the prevalence of selected behavioral and metabolic risk factors for non-communicable diseases and 10-years risk in development of coronary heart diseases (CHD). Two cross-sectional studies were conducted in urban and rural areas of Yangon Region in 2013 and 2014 respectively, using the WHO STEPwise approach to surveillance of risk factors of NCDs. Through a multi-stage cluster sampling method, 1486 participants were recruited. Age-standardized prevalence of the behavioral risk factors tended to be higher in the rural than urban areas for all included factors and significantly higher for alcohol drinking (19.9% vs. 13.9%; p = 0.040) and low fruit & vegetable consumption (96.7% vs. 85.1%; p = 0.001). For the metabolic risk factors, the tendency was opposite, with higher age-standardized prevalence estimates in urban than rural areas, significantly for overweight and obesity combined (40.9% vs. 31.2%; p = 0.023), obesity (12.3% vs.7.7%; p = 0.019) and diabetes (17.2% vs. 9.2%; p = 0.024). In sub-group analysis by gender, the prevalence of hypercholesterolemia and hypertriglyceridemia were significantly higher in urban than rural areas among males, 61.8% vs. 40.4%; p = 0.002 and 31.4% vs. 20.7%; p = 0.009, respectively. Mean values of age-standardized metabolic parameters showed higher values in urban than rural areas for both male and female. Based on WHO age-standardized Framingham risk scores, 33.0% (95% CI = 31.7-34.4) of urban dwellers and 27.0% (95% CI = 23.5-30.8) of rural dwellers had a moderate to high risk of developing CHD in the next

Evaluation of research on interventions aligned to WHO 'Best Buys' for NCDs in low-income and lower-middle-income countries: a systematic review from 1990 to 2015.

PubMed

Allen, Luke N; Pullar, Jessica; Wickramasinghe, Kremlin Khamarj; Williams, Julianne; Roberts, Nia; Mikkelsen, Bente; Varghese, Cherian; Townsend, Nick

2018-01-01

Non-communicable diseases (NCDs) are the leading cause of death and disability worldwide, with low-income and middle-income countries experiencing a disproportionately high burden. Since 2010 WHO has promoted 24 highly cost-effective interventions for NCDs, dubbed 'best buys'. It is unclear whether these interventions have been evaluated in low-income and lower-middle-income countries (LLMICs). To systematically review research on interventions aligned to WHO 'best buys' for NCDs in LLMICs. We searched 13 major databases and included papers conducted in the 83 World Bank-defined LLMICs, published between 1 January 1990 and 5 February 2015. Two reviewers independently screened papers and assessed risk of bias. We adopted a narrative approach to data synthesis. The primary outcomes were NCD-related mortality and morbidity, and risk factor prevalence. We identified 2672 records, of which 36 were included (608 940 participants). No studies on 'best buys' were found in 89% of LLMICs. Nineteen of the 36 studies reported on the effectiveness of tobacco-related 'best buys', presenting good evidence for group interventions in reducing tobacco use but weaker evidence for interventions targeting individuals. There were fewer studies on smoking bans, warning labels and mass media campaigns, and no studies on taxes or marketing restrictions. There was supportive evidence that cervical screening and hepatitis B immunisation prevent cancer in LLMICs. A single randomised controlled trial supported polypharmacy for cardiovascular disease. Fourteen of the 'best buy' interventions did not have any good evidence for effectiveness in LLMICs. We found studies on only 11 of the 24 interventions aligned with the WHO 'best buys' from LLMIC settings. Most LLMICs have not conducted research on these interventions in their populations. LLMICs should take action to implement and evaluate 'best buys' in their national context, based on national priorities, and starting with interventions with

Non-communicable diseases in low- and middle-income countries: context, determinants and health policy

PubMed Central

Miranda, J. J.; Kinra, S.; Casas, J. P.; Smith, G. Davey; Ebrahim, S.

2009-01-01

Summary The rise of non-communicable diseases and their impact in low- and middle-income countries has gained increased attention in recent years. However, the explanation for this rise is mostly an extrapolation from the history of high-income countries whose experience differed from the development processes affecting today’s low- and middle-income countries. This review appraises these differences in context to gain a better understanding of the epidemic of non-communicable diseases in low- and middle-income countries. Theories of developmental and degenerative determinants of non-communicable diseases are discussed to provide strong evidence for a causally informed approach to prevention. Health policies for non-communicable diseases are considered in terms of interventions to reduce population risk and individual susceptibility and the research needs for low- and middle-income countries are discussed. Finally, the need for health system reform to strengthen primary care is highlighted as a major policy to reduce the toll of this rising epidemic. PMID:18937743

Supermarket purchase contributes to nutrition-related non-communicable diseases in urban Kenya

PubMed Central

Klasen, Stephan; Nzuma, Jonathan M.; Qaim, Matin

2017-01-01

Background While undernutrition and related infectious diseases are still pervasive in many developing countries, the prevalence of non-communicable diseases (NCD), typically associated with high body mass index (BMI), is rapidly rising. The fast spread of supermarkets and related shifts in diets were identified as possible factors contributing to overweight and obesity in developing countries. Potential effects of supermarkets on people’s health have not been analyzed up till now. Objective This study investigates the effects of purchasing food in supermarkets on people’s BMI, as well as on health indicators such as fasting blood glucose (FBG), blood pressure (BP), and the metabolic syndrome. Design This study uses cross-section observational data from urban Kenya. Demographic, anthropometric, and bio-medical data were collected from 550 randomly selected adults. Purchasing food in supermarkets is defined as a binary variable that takes a value of one if any food was purchased in supermarkets during the last 30 days. In a robustness check, the share of food purchased in supermarkets is defined as a continuous variable. Instrumental variable regressions are applied to control for confounding factors and establish causality. Results Purchasing food in supermarkets contributes to higher BMI (+ 1.8 kg/m2) (P<0.01) and an increased probability (+ 20 percentage points) of being overweight or obese (P<0.01). Purchasing food in supermarkets also contributes to higher levels of FBG (+ 0.3 mmol/L) (P<0.01) and a higher likelihood (+ 16 percentage points) of suffering from pre-diabetes (P<0.01) and the metabolic syndrome (+ 7 percentage points) (P<0.01). Effects on BP could not be observed. Conclusions Supermarkets and their food sales strategies seem to have direct effects on people’s health. In addition to increasing overweight and obesity, supermarkets contribute to nutrition-related NCDs. Effects of supermarkets on nutrition and health can mainly be ascribed to

Effect of the vegetarian diet on non-communicable diseases.

PubMed

Li, Duo

2014-01-30

A vegetarian diet generally includes plenty of vegetables and fruits, which are rich in phytochemicals, antioxidants, fiber, magnesium, vitamins C and E, Fe³⁺, folic acid and n-6 polyunsaturated fatty acid (PUFA), and is low in cholesterol, total fat and saturated fatty acid, sodium, Fe²⁺, zinc, vitamin A, B₁₂ and D, and especially n-3 PUFA. Mortality from all-cause, ischemic heart disease, and circulatory and cerebrovascular diseases was significantly lower in vegetarians than in omnivorous populations. Compared with omnivores, the incidence of cancer and type 2 diabetes was also significantly lower in vegetarians. However, vegetarians have a number of increased risk factors for non-communicable diseases such as increased plasma homocysteine, mean platelet volume and platelet aggregability compared with omnivores, which are associated with low intake of vitamin B₁₂ and n-3 PUFA. Based on the present data, it would seem appropriate for vegetarians to carefully design their diet, specifically focusing on increasing their intake of vitamin B₁₂ and n-3 PUFA to further reduce already low mortality and morbidity from non-communicable diseases. © 2013 Society of Chemical Industry.

The Fertility Management Experiences of Australian Women with a Non-communicable Chronic Disease: Findings from the Understanding Fertility Management in Contemporary Australia Survey.

PubMed

Holton, Sara; Thananjeyan, Aberaami; Rowe, Heather; Kirkman, Maggie; Jordan, Lynne; McNamee, Kathleen; Bayly, Christine; McBain, John; Sinnott, Vikki; Fisher, Jane

2018-06-01

Introduction Despite the considerable and increasing proportion of women of reproductive age with a chronic non-communicable disease (NCD) and the potential adverse implications of many NCDs for childbearing, little is known about the fertility management experiences of women with an NCD, including their contraceptive use, pregnancy experiences and outcomes, and reproductive health care utilisation. The aim of this study was to investigate the fertility management experiences of women with an NCD and draw comparisons with women without an NCD. Method A sample of 18-50 year-old women (n = 1543) was randomly recruited from the Australian electoral roll in 2013. Of these women, 172 women reported a physical, chronic non-communicable disease: diabetes, arthritis, asthma, hypertension, heart disease, thyroid disorders, and cystic fibrosis. Respondents completed an anonymous, self-administered questionnaire. Factors associated with fertility management were identified in multivariable analyses. Results Women who reported having an NCD were significantly more likely than women who did not report an NCD to have ever been pregnant (75.9 vs. 67.5%, p = 0.034), have had an unintended pregnancy (33.47 vs. 25.5%, p = 0.026), and have had an abortion (20.3 vs. 14.2%, p = 0.044); they were less likely to consult a healthcare provider about fertility management (45.0 vs. 54.4%, p = 0.024). Similar proportions were using contraception (48.8 vs. 54.5%, p = 0.138). Conclusion The findings have implications for healthcare providers and women with an NCD and highlight the importance of addressing possible assumptions about the inability of women with an NCD to become pregnant, and ensuring women receive information about suitable methods of contraception and pre-pregnancy care.

An assessment of non-communicable diseases, diabetes, and related risk factors in the Republic of the Marshall Islands, Majuro Atoll: a systems perspective.

PubMed

Ichiho, Henry M; deBrum, Ione; Kedi, Shra; Langidrik, Justina; Aitaoto, Nia

2013-05-01

Non-communicable diseases (NCD) have been identified as a health emergency in the US-associated Pacific Islands (USAPI).1 This assessment, funded by the National Institutes of Health, was conducted in the Republic of the Marshall Islands, Majuro Atoll and describes the burdens due to selected NCD (diabetes, heart disease, hypertension, stroke, chronic kidney disease); and assesses the system of service capacity and current activities for service delivery, data collection and reporting as well as identifying the issues that need to be addressed. Findings reveal that the risk factors of poor diet, lack of physical activity, and risky lifestyle behaviors are associated with overweight and obesity and subsequent NCD that are significant factors in the morbidity and mortality of the population. The leading causes of death include sepsis, cancer, diabetes-related deaths, pneumonia, and hypertension. Population-based survey for the RMI show that 62.5% of the adults are overweight or obese and the prevalence of diabetes stands at 19.6%. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address these NCD. There is no policy and procedure manual for the hospital or public health diabetes clinics and there is little communication, coordination, or collaboration between the medical and public health staff. There is no functional data system that allows for the identification, registry, or tracking of patients with diabetes or other NCDs. Based on these findings, priority issues and problems to be addressed for the administrative, clinical, and data systems were identified.

An Assessment of Non-Communicable Diseases, Diabetes, and Related Risk Factors in the Republic of the Marshall Islands, Majuro Atoll: A Systems Perspective

PubMed Central

deBrum, Ione; Kedi, Shra; Langidrik, Justina; Aitaoto, Nia

2013-01-01

Non-communicable diseases (NCD) have been identified as a health emergency in the US-associated Pacific Islands (USAPI).1 This assessment, funded by the National Institutes of Health, was conducted in the Republic of the Marshall Islands, Majuro Atoll and describes the burdens due to selected NCD (diabetes, heart disease, hypertension, stroke, chronic kidney disease); and assesses the system of service capacity and current activities for service delivery, data collection and reporting as well as identifying the issues that need to be addressed. Findings reveal that the risk factors of poor diet, lack of physical activity, and risky lifestyle behaviors are associated with overweight and obesity and subsequent NCD that are significant factors in the morbidity and mortality of the population. The leading causes of death include sepsis, cancer, diabetes-related deaths, pneumonia, and hypertension. Population-based survey for the RMI show that 62.5% of the adults are overweight or obese and the prevalence of diabetes stands at 19.6%. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address these NCD. There is no policy and procedure manual for the hospital or public health diabetes clinics and there is little communication, coordination, or collaboration between the medical and public health staff. There is no functional data system that allows for the identification, registry, or tracking of patients with diabetes or other NCDs. Based on these findings, priority issues and problems to be addressed for the administrative, clinical, and data systems were identified. PMID:23901367

Educational Outreach with an Integrated Clinical Tool for Nurse-Led Non-communicable Chronic Disease Management in Primary Care in South Africa: A Pragmatic Cluster Randomised Controlled Trial.

PubMed

Fairall, Lara R; Folb, Naomi; Timmerman, Venessa; Lombard, Carl; Steyn, Krisela; Bachmann, Max O; Bateman, Eric D; Lund, Crick; Cornick, Ruth; Faris, Gill; Gaziano, Thomas; Georgeu-Pepper, Daniella; Zwarenstein, Merrick; Levitt, Naomi S

2016-11-01

In many low-income countries, care for patients with non-communicable diseases (NCDs) and mental health conditions is provided by nurses. The benefits of nurse substitution and supplementation in NCD care in high-income settings are well recognised, but evidence from low- and middle-income countries is limited. Primary Care 101 (PC101) is a programme designed to support and expand nurses' role in NCD care, comprising educational outreach to nurses and a clinical management tool with enhanced prescribing provisions. We evaluated the effect of the programme on primary care nurses' capacity to manage NCDs. In a cluster randomised controlled trial design, 38 public sector primary care clinics in the Western Cape Province, South Africa, were randomised. Nurses in the intervention clinics were trained to use the PC101 management tool during educational outreach sessions delivered by health department trainers and were authorised to prescribe an expanded range of drugs for several NCDs. Control clinics continued use of the Practical Approach to Lung Health and HIV/AIDS in South Africa (PALSA PLUS) management tool and usual training. Patients attending these clinics with one or more of hypertension (3,227), diabetes (1,842), chronic respiratory disease (1,157) or who screened positive for depression (2,466), totalling 4,393 patients, were enrolled between 28 March 2011 and 10 November 2011. Primary outcomes were treatment intensification in the hypertension, diabetes, and chronic respiratory disease cohorts, defined as the proportion of patients in whom treatment was escalated during follow-up over 14 mo, and case detection in the depression cohort. Primary outcome data were analysed for 2,110 (97%) intervention and 2,170 (97%) control group patients. Treatment intensification rates in intervention clinics were not superior to those in the control clinics (hypertension: 44% in the intervention group versus 40% in the control group, risk ratio [RR] 1.08 [95% CI 0.94 to 1

Burden of Mental Illness and Non-communicable Diseases and Risk Factors for Mental Illness Among Refugees in Buffalo, NY, 2004-2014.

PubMed

Mulugeta, Wudeneh; Xue, Hong; Glick, Myron; Min, Jungwon; Noe, Michael F; Wang, Youfa

2018-05-21

Limited is known about mental illness and non-communicable diseases (NCDs) and their risk factors among refugees. These were studied using data collected from a refugee population in Buffalo, NY. Longitudinal data collected on 1055 adults (> 18 years) at a large refugee health center in Buffalo, NY, during 2004-2014 were used. Main outcomes were hypertension, diabetes, tobacco use, obesity, overweight/obesity, and mental illness. Risk factors were assessed using multivariate regression models. Compared to those without mental illness, refugees with mental illness had higher rates of hypertension (16.9 vs 28.4%, P < 0.001), diabetes (8.4 vs 13.6%, P = 0.03), tobacco use (9.3 vs 18.3%, P < 0.001), obesity (13.0 vs 25.4%, P < 0.001), and overweight/obesity rates (45.0 vs 61.5%, P < 0.001). During 2004-2014, obesity rates increased among those with mental illness (25.4 to 36.7%, P < 0.001) and without mental illness (13.0 to 24.5%, P < 0.001). The overall mental illness prevalence among refugees was 16%, ranging from 6.9% among Asians to 43.9% among Cubans. Women were more likely to have mental illness (odds ratio = 2.45; 95% confidence interval [CI] = 1.68-3.58) than men. Refugees who lived longer in the USA were more likely to carry psychiatric diagnoses (OR = 1.12; 95% CI = 1.04-1.21). Mental illness rates varied considerably across various refugee groups. Rates of obesity and NCDs among refugees with mental illness were higher than among those without mental disorders. Gender, region of origin, and length of stay in the USA were associated with mental illness. Accurate and culturally sensitive screenings and assessments of mental illness are needed to reduce these health disparities.

Cycling promotion and non-communicable disease prevention: health impact assessment and economic evaluation of cycling to work or school in Florence.

PubMed

Taddei, Cristina; Gnesotto, Roberto; Forni, Silvia; Bonaccorsi, Guglielmo; Vannucci, Andrea; Garofalo, Giorgio

2015-01-01

To estimate the effects of cycling promotion on major non-communicable diseases (NCDs) and costs from the public healthcare payer's perspective. Health impact assessment and economic evaluation using a dynamic model over a ten-year period and according to two cycling promotion scenarios. Cycling to work or school in Florence, Italy. All individuals aged 15 and older commuting to work or school in Florence. The primary outcome measures were changes in NCD incidence and healthcare direct costs for the Tuscany Regional Health Service (SST) due to increased cycling. The secondary outcome was change in road traffic accidents. Increasing cycling modal share in Florence from 7.5% to about 17% (Scenario 1) or 27% (Scenario 2) could decrease the incidence of type 2 diabetes by 1.2% or 2.5%, and the incidence of acute myocardial infarction (AMI) and stroke by 0.6% or 1.2%. Within 10 years, the number of cases that can be prevented is 280 or 549 for type 2 diabetes, 51 or 100 for AMI, and 51 or 99 for stroke in Scenario 1 or Scenario 2, respectively. Average annual discounted savings for the SST are estimated to amount to €400,804 or €771,201 in Scenario 1 or Scenario 2, respectively. In Florence, due to the high use of vulnerable motorized vehicles (such as scooters, mopeds, and motorcycles), road traffic accidents are expected to decline in both our scenarios. Sensitivity analyses showed that health benefits and savings for the SST are substantial, the most sensitive parameters being the relative risk estimates of NCDs and active commuting. Effective policies and programs to promote a modal shift towards cycling among students and workers in Florence will contribute to reducing the NCD burden and helping long-term economic sustainability of the SST.

Gender differences in the relationship between built environment and non-communicable diseases: A systematic review.

PubMed

Valson, Joanna Sara; Kutty, V Raman

2018-02-05

Non-communicable diseases are on the rise globally. Risk factors of non-communicable diseases continue to be a growing concern in both developed and developing countries. With significant rise in population and establishment of buildings, rapid changes have taken place in the built environment. Relationship between health and place, particularly with non-communicable diseases has been established in previous literature. This systematic review assesses the current evidence on influence of gender in the relationship between built environment and non-communicable diseases. A systematic literature search using PubMed was done to identify all studies that reported relationship between gender and built environment. All titles and abstracts were scrutinised to include only articles based on risk factors, prevention, treatment and outcome of non-communicable diseases. The Gender Analysis Matrix developed by the World Health Organization was used to describe the findings of gender differences. Sex differences, biological susceptibility, gender norms/ values, roles and activities related to gender and access to/control over resources were themes for the differences in the relationship. A total of 15 out of 214 articles met the inclusion criteria. Majority of the studies were on risk factors of non-communicable diseases, particularly cardiovascular diseases. Gender differences in physical access to recreational facilities, neighbourhood perceptions of safety and walkability have been documented. Men and women showed differential preferences to walking, engaging in physical activity and in perceiving safety of the neighbourhood. Girls and boys showed differences in play activities at school and in their own neighbourhood environment. Safety from crime and safety from traffic were also perceived important to engage in physical activity. Gender norms and gender roles and activities have shown basis for the differences in the prevalence of non-communicable diseases. Sparse

Engagement of adolescents in a health communications program to prevent noncommunicable diseases: Multiplicadores Jóvenes, Lima, Peru, 2011.

PubMed

Diez-Canseco, Francisco; Boeren, Yulissa; Quispe, Renato; Chiang, Mey Lin; Miranda, J Jaime

2015-03-05

Several risk factors for noncommunicable diseases (NCDs), including obesity, are associated with behaviors established in infancy that persist throughout adolescence and adulthood. As such, adolescents should be engaged in the design and implementation of NCD prevention strategies. In Lima, Peru's capital, the proportion of adolescents aged 15 to 19 is 9.3% of the city's population, and school enrollment rates are high. The prevalence of excess weight in Peruvian adolescents is 14.2%, and prevalence has not declined in recent years. Also recently, NCDs and their risk factors have gained more attention in public health and policy areas, with regulatory action focusing on healthful nutrition to address obesity and related NCDs. The Multiplicadores Jóvenes (Young Multipliers) project was conducted among adolescents aged 15 to 17 from 9 public secondary schools in peri-urban areas of Lima, Peru. The project provided basic communication tools and knowledge of NCD prevention and public health research to adolescents during 16 weekly participatory sessions to enable them to design and disseminate healthful lifestyle promotion messages to their school peers. Thirty of 45 participants finished the program. Seven communications campaigns were designed and implemented in schools, reaching 1,200 students. The participants gained motivation, increased knowledge, and developed communication skills that were combined to implement healthful lifestyle promotion campaigns. Engaging young people in public health promotion activities was feasible and advantageous for the design of tailored prevention-related content and its dissemination among peers.

Developmental Programming of Adult Disease: Reprogramming by Melatonin?

PubMed Central

Tain, You-Lin; Huang, Li-Tung; Hsu, Chien-Ning

2017-01-01

Adult-onset chronic non-communicable diseases (NCDs) can originate from early life through so-called the “developmental origins of health and disease” (DOHaD) or “developmental programming”. The DOHaD concept offers the “reprogramming” strategy to shift the treatment from adulthood to early life, before clinical disease is apparent. Melatonin, an endogenous indoleamine produced by the pineal gland, has pleiotropic bioactivities those are beneficial in a variety of human diseases. Emerging evidence support that melatonin is closely inter-related to other proposed mechanisms contributing to the developmental programming of a variety of chronic NCDs. Recent animal studies have begun to unravel the multifunctional roles of melatonin in many experimental models of developmental programming. Even though some progress has been made in research on melatonin as a reprogramming strategy to prevent DOHaD-related NCDs, future human studies should aim at filling the translational gap between animal models and clinical trials. Here, we review several key themes on the reprogramming effects of melatonin in DOHaD research. We have particularly focused on the following areas: mechanisms of developmental programming; the interrelationship between melatonin and mechanisms underlying developmental programming; pathophysiological roles of melatonin in pregnancy and fetal development; and insight provided by animal models to support melatonin as a reprogramming therapy. Rates of NCDs are increasing faster than anticipated all over the world. Hence, there is an urgent need to understand reprogramming mechanisms of melatonin and to translate experimental research into clinical practice for halting a growing list of DOHaD-related NCDs. PMID:28212315

Effective components of exercise and physical activity-related behaviour-change interventions for chronic non-communicable diseases in Africa: protocol for a systematic mixed studies review with meta-analysis.

PubMed

Igwesi-Chidobe, Chinonso N; Godfrey, Emma L; Kengne, Andre P

2015-08-12

Chronic non-communicable diseases (NCDs) account for a high burden of mortality and morbidity in Africa. Evidence-based clinical guidelines recommend exercise training and promotion of physical activity behaviour changes to control NCDs. Developing such interventions in Africa requires an understanding of the essential components that make them effective in this context. This is a protocol for a systematic mixed studies review that aims to determine the effective components of exercise and physical activity-related behaviour-change interventions for chronic diseases in Africa, by combining quantitative and qualitative research evidence from studies published until July 2015. We will conduct a detailed search to identify all published and unpublished studies that assessed the effects of exercise and physical activity-related interventions or the experiences/perspectives of patients to these interventions for NCDs from bibliographic databases and the grey literature. Bibliographic databases include MEDLINE, EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), PsycINFO, CINAHL and Web of Science. We will include the following African regional databases: African Index Medicus (AIM) and AFROLIB, which is the WHO's regional office database for Africa. The databases will be searched from inception until 18 July 2015. Appraisal of study quality will be performed after results synthesis. Data synthesis will be performed independently for quantitative and qualitative data using a mixed methods sequential explanatory synthesis for systematic mixed studies reviews. Meta-analysis will be conducted for the quantitative studies, and thematic synthesis for qualitative studies and qualitative results from the non-controlled observational studies. The primary outcome will include exercise adherence and physical activity behaviour changes. This review protocol is reported according to Preferred Reporting Items for Systematic reviews and Meta-Analysis protocols (PRISMA

Oxygen Sensing, Hypoxia Tracing and in Vivo Imaging with Functional Metalloprobes for the Early Detection of Non-communicable Diseases

PubMed Central

Mirabello, Vincenzo; Cortezon-Tamarit, Fernando; Pascu, Sofia I.

2018-01-01

Hypoxia has been identified as one of the hallmarks of tumor environments and a prognosis factor in many cancers. The development of ideal chemical probes for imaging and sensing of hypoxia remains elusive. Crucial characteristics would include a measurable response to subtle variations of pO2 in living systems and an ability to accumulate only in the areas of interest (e.g., targeting hypoxia tissues) whilst exhibiting kinetic stabilities in vitro and in vivo. A sensitive probe would comprise platforms for applications in imaging and therapy for non-communicable diseases (NCDs) relying on sensitive detection of pO2. Just a handful of probes for the in vivo imaging of hypoxia [mainly using positron emission tomography (PET)] have reached the clinical research stage. Many chemical compounds, whilst presenting promising in vitro results as oxygen-sensing probes, are facing considerable disadvantages regarding their general application in vivo. The mechanisms of action of many hypoxia tracers have not been entirely rationalized, especially in the case of metallo-probes. An insight into the hypoxia selectivity mechanisms can allow an optimization of current imaging probes candidates and this will be explored hereby. The mechanistic understanding of the modes of action of coordination compounds under oxygen concentration gradients in living cells allows an expansion of the scope of compounds toward in vivo applications which, in turn, would help translate these into clinical applications. We summarize hereby some of the recent research efforts made toward the discovery of new oxygen sensing molecules having a metal-ligand core. We discuss their applications in vitro and/or in vivo, with an appreciation of a plethora of molecular imaging techniques (mainly reliant on nuclear medicine techniques) currently applied in the detection and tracing of hypoxia in the preclinical and clinical setups. The design of imaging/sensing probe for early-stage diagnosis would longer term

Epidemiology of Major Non-communicable Diseases in Ethiopia: A Systematic Review

PubMed Central

Mariam, Damen Haile; Ali, Ahmed; Araya, Tekebash

2014-01-01

Impact of non-communicable diseases is not well-documented in Ethiopia. We aimed to document the prevalence and mortality associated with four major non-communicable diseases in Ethiopia: cardiovascular disease, cancer, diabetes, and chronic obstructive pulmonary disease. Associated risk factors: hypertension, tobacco-use, harmful use of alcohol, overweight/obesity, and khat-chewing were also studied. Systematic review of peer-reviewed and grey literature between 1960 and 2011 was done using PubMed search engines and local libraries to identify prevalence studies on the four diseases. In total, 32 studies were found, and half of these studies were from Addis Ababa. Two hospital-based studies reviewed the prevalence of cardiovascular disease and found a prevalence of 7.2% and 24%; a hospital-based study reviewed cancer prevalence and found a prevalence of 0.3%; two hospital-based studies reviewed diabetes prevalence and found a prevalence of 0.5% and 1.2%; and two hospital-based studies reviewed prevalence of asthma and found a prevalence of 1% and 3.5%. Few community-based studies were done on the prevalence of diabetes and chronic pulmonary obstructive disease among the population. Several studies reviewed the impact of these diseases on mortality: cardiovascular disease accounts for 24% of deaths in Addis Ababa, cancer causes 10% of deaths in the urban settings and 2% deaths in rural setting, and diabetes causes 5% and chronic obstructive pulmonary disease causes 3% of deaths. Several studies reviewed the impact of these diseases on hospital admissions: cardiovascular disease accounts for 3%-12.6% and found to have increased between 1970s and 2000s; cancer accounts for 1.1%-2.8%, diabetes accounts for 0.5%-1.2%, and chronic obstructive diseases account for 2.7%-4.3% of morbidity. Overall, the major non-communicable diseases and related risk factors are highly prevalent, and evidence-based interventions should be designed. PMID:24847587

Oral hygiene status in a general population of Iran, 2011: a key lifestyle marker in relation to common risk factors of non-communicable diseases.

PubMed

Asgari, Fereshteh; Majidi, Azam; Koohpayehzadeh, Jalil; Etemad, Koorosh; Rafei, Ali

2015-01-30

To estimate Oral Hygiene (OH) status in the Iranian population in 2011, and to determine the influence of socio-economic characteristics on OH, and its interrelation with common risk factors of Non-Communicable Diseases (NCDs). Data including a total of 12,105 individuals aged 6-70 years were obtained from the sixth round of the surveys of NCDs risk factors in Iran. OH was recorded through a structured questionnaire measuring daily frequencies of tooth brushing and dental flossing. Descriptive analyses were performed on demographic characteristics in the complex sample survey setting. We also employed weighted binary logistic regression to compute Odds Ratio (OR) as a measure of association between the response and explanatory factors. Furthermore, to construct an asset index, we utilized Principal Component Analysis (PCA). The percentage with minimum recommended daily OH practices was 3.7% among men and 7.7% among women (OR= 2.3; P<0.001). Urban citizens were more likely to have their teeth cleaned compared to rural people (OR= 2.8; P<0.001). For both genders, a relatively better condition was observed in the 25-34 age group (male: 5.6%; female: 10.3%). In addition, OH status improved significantly by increase in both level of education (P<0.001) and economic status (P<0.001). There were also apparent associations between self-care practices and specific behavioral risk factors, though the correlation with dietary habits and tobacco use could be largely explained by socio-economic factors. OH situation in Iran calls for urgent need to assign proper interventions and strategies toward raising public awareness and reducing disparities in access to health facilities. © 2015 by Kerman University of Medical Sciences.

The Development of Public Policies to Address Non-communicable Diseases in the Caribbean Country of Barbados: The Importance of Problem Framing and Policy Entrepreneurs

PubMed Central

Unwin, Nigel; Samuels, T. Alafia; Hassell, Trevor; Brownson, Ross C.; Guell, Cornelia

2017-01-01

Background: Government policy measures have a key role to play in the prevention and control of non-communicable diseases (NCDs). The Caribbean, a middle-income region, has the highest per capita burden of NCDs in the Americas. Our aim was to examine policy development and implementation between the years 2000 and 2013 on NCD prevention and control in Barbados, and to investigate factors promoting, and hindering, success. Methods: A qualitative case study design was used involving a structured policy document review and semi-structured interviews with key informants, identified through stakeholder analysis and ‘cascading.’ Documents were abstracted into a standard form. Interviews were recorded, transcribed verbatim and underwent framework analysis, guided by the multiple streams framework (MSF). There were 25 key informants, from the Ministry of Health (MoH), other government Ministries, civil society organisations, and the private sector. Results: A significant policy window opened between 2005 and 2007 in which new posts to address NCDs were created in the MoH, and a government supported multi-sectoral national NCD commission was established. Factors contributing to this government commitment and funding included a high level of awareness, throughout society, of the NCD burden, including media coverage of local research findings; the availability of policy recommendations by international bodies that could be adopted locally, notably the framework convention on tobacco control (FCTC); and the activities of local highly respected policy entrepreneurs with access to senior politicians, who were able to bring together political concern for the problem with potential policy solutions. However, factors were also identified that hindered multi-sectoral policy development in several areas, including around nutrition, physical activity, and alcohol. These included a lack of consensus (valence) on the nature of the problem, often framed as being predominantly one of

An assessment of non-communicable diseases, diabetes, and related risk factors in the Republic of the Marshall Islands, Kwajelein Atoll, Ebeye Island: a systems perspective.

PubMed

Ichiho, Henry M; Seremai, Johannes; Trinidad, Richard; Paul, Irene; Langidrik, Justina; Aitaoto, Nia

2013-05-01

Non-communicable diseases (NCD) have been declared a health emergency in the US-affiliated Pacific Islands (USAPI). This assessment, funded by the National Institutes of Health, was conducted on Ebeye Island of Kwajelein Atoll, Republic of the Marshall Islands (RMI) to describe the burdens due to selected NCD (diabetes, heart disease, hypertension, stroke, chronic kidney disease); assess the system of service capacity and activities for service delivery, data collection, and reporting; and identify the key issues that need to be addressed. Findings reveal that the risk factors of poor diet, lack of physical activity, and lifestyle behaviors lead to overweight and obesity and subsequent NCD that impact the morbidity and mortality of the population. Population survey of the RMI show that 62.5% of the total population is overweight or obese with a dramatic increase from the 15-24 year old (10.6%) and the 25-64 year old (41.9%) age groups. The leading causes of death were septicemia, renal failure, pneumonia, cancer, and myocardial infarction. Other findings show gaps in the system of administrative, clinical, and support services to address these NCD. All health care in Ebeye is provided in one setting and there is collaboration, coordination, and communication among medical and health care providers. The Book of Protocols for the Kwajalein Atoll Health Care Bureau provides the guidelines, standards, and policy and procedures for the screening, diagnosis, and management of diabetes and other NCDs. Based on these findings, priority issues and problems to be addressed for the administrative, clinical, and data systems were identified.

An Assessment of Non-Communicable Diseases, Diabetes, and Related Risk Factors in the Republic of the Marshall Islands, Kwajelein Atoll, Ebeye Island: A Systems Perspective

PubMed Central

Seremai, Johannes; Trinidad, Richard; Paul, Irene; Langidrik, Justina; Aitaoto, Nia

2013-01-01

Non-communicable diseases (NCD) have been declared a health emergency in the US-affiliated Pacific Islands (USAPI).1 This assessment, funded by the National Institutes of Health, was conducted on Ebeye Island of Kwajelein Atoll, Republic of the Marshall Islands (RMI) to describe the burdens due to selected NCD (diabetes, heart disease, hypertension, stroke, chronic kidney disease); assess the system of service capacity and activities for service delivery, data collection, and reporting; and identify the key issues that need to be addressed. Findings reveal that the risk factors of poor diet, lack of physical activity, and lifestyle behaviors lead to overweight and obesity and subsequent NCD that impact the morbidity and mortality of the population. Population survey of the RMI show that 62.5% of the total population is overweight or obese with a dramatic increase from the 15–24 year old (10.6%) and the 25–64 year old (41.9%) age groups. The leading causes of death were septicemia, renal failure, pneumonia, cancer, and myocardial infarction. Other findings show gaps in the system of administrative, clinical, and support services to address these NCD. All health care in Ebeye is provided in one setting and there is collaboration, coordination, and communication among medical and health care providers. The Book of Protocols for the Kwajalein Atoll Health Care Bureau provides the guidelines, standards, and policy and procedures for the screening, diagnosis, and management of diabetes and other NCDs. Based on these findings, priority issues and problems to be addressed for the administrative, clinical, and data systems were identified. PMID:23901366

Engagement of Adolescents in a Health Communications Program to Prevent Noncommunicable Diseases: Multiplicadores Jóvenes, Lima, Peru, 2011

PubMed Central

Diez-Canseco, Francisco; Boeren, Yulissa; Quispe, Renato; Chiang, Mey lin

2015-01-01

Background Several risk factors for noncommunicable diseases (NCDs), including obesity, are associated with behaviors established in infancy that persist throughout adolescence and adulthood. As such, adolescents should be engaged in the design and implementation of NCD prevention strategies. Community Context In Lima, Peru’s capital, the proportion of adolescents aged 15 to 19 is 9.3% of the city’s population, and school enrollment rates are high. The prevalence of excess weight in Peruvian adolescents is 14.2%, and prevalence has not declined in recent years. Also recently, NCDs and their risk factors have gained more attention in public health and policy areas, with regulatory action focusing on healthful nutrition to address obesity and related NCDs. The Multiplicadores Jóvenes (Young Multipliers) project was conducted among adolescents aged 15 to 17 from 9 public secondary schools in peri-urban areas of Lima, Peru. Methods The project provided basic communication tools and knowledge of NCD prevention and public health research to adolescents during 16 weekly participatory sessions to enable them to design and disseminate healthful lifestyle promotion messages to their school peers. Outcome Thirty of 45 participants finished the program. Seven communications campaigns were designed and implemented in schools, reaching 1,200 students. The participants gained motivation, increased knowledge, and developed communication skills that were combined to implement healthful lifestyle promotion campaigns. Interpretation Engaging young people in public health promotion activities was feasible and advantageous for the design of tailored prevention-related content and its dissemination among peers. PMID:25742065

Educational Outreach with an Integrated Clinical Tool for Nurse-Led Non-communicable Chronic Disease Management in Primary Care in South Africa: A Pragmatic Cluster Randomised Controlled Trial

PubMed Central

Lombard, Carl; Steyn, Krisela; Bachmann, Max O.; Bateman, Eric D.; Lund, Crick; Faris, Gill; Gaziano, Thomas; Georgeu-Pepper, Daniella; Zwarenstein, Merrick; Levitt, Naomi S.

2016-01-01

Background In many low-income countries, care for patients with non-communicable diseases (NCDs) and mental health conditions is provided by nurses. The benefits of nurse substitution and supplementation in NCD care in high-income settings are well recognised, but evidence from low- and middle-income countries is limited. Primary Care 101 (PC101) is a programme designed to support and expand nurses’ role in NCD care, comprising educational outreach to nurses and a clinical management tool with enhanced prescribing provisions. We evaluated the effect of the programme on primary care nurses’ capacity to manage NCDs. Methods and Findings In a cluster randomised controlled trial design, 38 public sector primary care clinics in the Western Cape Province, South Africa, were randomised. Nurses in the intervention clinics were trained to use the PC101 management tool during educational outreach sessions delivered by health department trainers and were authorised to prescribe an expanded range of drugs for several NCDs. Control clinics continued use of the Practical Approach to Lung Health and HIV/AIDS in South Africa (PALSA PLUS) management tool and usual training. Patients attending these clinics with one or more of hypertension (3,227), diabetes (1,842), chronic respiratory disease (1,157) or who screened positive for depression (2,466), totalling 4,393 patients, were enrolled between 28 March 2011 and 10 November 2011. Primary outcomes were treatment intensification in the hypertension, diabetes, and chronic respiratory disease cohorts, defined as the proportion of patients in whom treatment was escalated during follow-up over 14 mo, and case detection in the depression cohort. Primary outcome data were analysed for 2,110 (97%) intervention and 2,170 (97%) control group patients. Treatment intensification rates in intervention clinics were not superior to those in the control clinics (hypertension: 44% in the intervention group versus 40% in the control group, risk

Income Inequality in Non-communicable Diseases Mortality among the Regions of the Slovak Republic.

PubMed

Gavurová, Beáta; Kováč, Viliam; Šoltés, Michal; Kot, Sebastian; Majerník, Jaroslav

2017-12-01

A great amount of non-communicable disease deaths poses a threat for all people and therefore represents the challenge for health policy makers, health providers and other health or social policy actors. The aim of this study is to analyse regional differences in non-communicable disease mortality in the Slovak Republic, and to quantify the relationship between mortality and economic indicators of the Slovak regions. Standardised mortality rates adjusted for age, sex, region, and period were calculated applying direct standardisation methods with the European standard population covering the time span from 2005 to 2013. The impact of income indicators on standardised mortality rates was calculated using the panel regression models. The Bratislava region reaches the lowest values of standardised mortality rate for non-communicable diseases for both sexes. On the other side, the Nitra region has the highest standardised mortality rate for non-communicable diseases. Income quintile ratio has the highest effect on mortality, however, the expected positive impact is not confirmed. Gini coefficient at the 0.001 significance level and social benefits at the 0.01 significance level look like the most influencing variables on the standardised mortality rate. By addition of one percentage point of Gini coefficient, mortality rate increases by 148.19 units. When a share of population receiving social benefits increases by one percentage point, the standardised mortality rate will increase by 22.36 units. Non-communicable disease mortality together with income inequalities among the regions of the Slovak Republic highlight the importance of economic impact on population health. Copyright© by the National Institute of Public Health, Prague 2017.

Effect of Promotional Initiatives on Visits to a Dedicated Website for Physical Activity and Non-Communicable Disease in Luxembourg: An Event Study

PubMed Central

Lion, Alexis; Thornton, Jane S.; Vaillant, Michel; Pertuy, Juliette; Besenius, Eric; Hardy, Cyrille; Delagardelle, Charles; Seil, Romain; Urhausen, Axel; Theisen, Daniel

2017-01-01

The Sport-Santé project and its website (www.sport-sante.lu) promote physical activity for individuals with non-communicable diseases (NCDs) in Luxembourg. Our purpose was to perform an event study analysis to evaluate the effects of communication and promotional initiatives on the number of visits to the Sport-Santé website. Between September 2015 and May 2016, the Sport-Santé website was promoted during different initiatives, including participation in health-related events or publication of articles in local journals. The daily number of visits to www.sport-sante.lu website (i.e., our outcome) was recorded using Google Analytics and compared to a counterfactual collected with its benchmarking tool. The counterfactual was defined as the daily number of visits to websites in the same field. A model was created to evaluate the relationship between the number of visits to www.sport-sante.lu website and the number of visits to similar websites during a control period with no promotional initiatives (from July 2015 to September 2015). The effect of promotional initiatives was subsequently tested, by comparing the actual number of visits to our website (up to 2 days after each event) with the theoretical number of visits predicted by the model. Twenty-two initiatives were identified, of which 11 were participations at major health-related events and 11 publications of popular science articles. Of these 22 initiatives, the event study identified 2 popular science articles and 1 interactive workshop that significantly increased the daily number of visits to the www.sport-sante.lu website. One of the two articles was published on the day before the workshop was held, which did not allow us to distinguish its specific impact. The second article was published in the main national newspaper. This is the first time to our knowledge that an event study analysis has been used to evaluate the impact of promotional initiatives on the number of visits to a dedicated website

A qualitative study of governance of evolving response to non-communicable diseases in low-and middle- income countries: current status, risks and options.

PubMed

Rani, Manju; Nusrat, Sharmin; Hawken, Laura H

2012-10-16

Segmented service delivery with consequent inefficiencies in health systems was one of the main concerns raised during scaling up of disease-specific programs in the last two decades. The organized response to NCD is in infancy in most LMICs with little evidence on how the response is evolving in terms of institutional arrangements and policy development processes. Drawing on qualitative review of policy and program documents from five LMICs and data from global key-informant surveys conducted in 2004 and 2010, we examine current status of governance of response to NCDs at national level along three dimensions- institutional arrangements for stewardship and program management and implementation; policies/plans; and multisectoral coordination and partnerships. Several positive trends were noted in the organization and governance of response to NCDs: shift from specific NCD-based programs to integrated NCD programs, increasing inclusion of NCDs in sector-wide health plans, and establishment of high-level multisectoral coordination mechanisms.Several areas of concern were identified. The evolving NCD-specific institutional structures are being treated as 'program management and implementation' entities rather than as lead 'technical advisory' bodies, with unclear division of roles and responsibilities between NCD-specific and sector-wide structures. NCD-specific and sector-wide plans are poorly aligned and lack prioritization, costing, and appropriate targets. Finally, the effectiveness of existing multisectoral coordination mechanisms remains questionable. The 'technical functions' and 'implementation and management functions' should be clearly separated between NCD-specific units and sector-wide institutional structures to avoid duplicative segmented service delivery systems. Institutional capacity building efforts for NCDs should target both NCD-specific units (for building technical and analytical capacity) and sector-wide organizational units (for building

Adult non-communicable disease mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites

PubMed Central

Streatfield, P. Kim; Khan, Wasif A.; Bhuiya, Abbas; Hanifi, Syed M.A.; Alam, Nurul; Bagagnan, Cheik H.; Sié, Ali; Zabré, Pascal; Lankoandé, Bruno; Rossier, Clementine; Soura, Abdramane B.; Bonfoh, Bassirou; Kone, Siaka; Ngoran, Eliezer K.; Utzinger, Juerg; Haile, Fisaha; Melaku, Yohannes A.; Weldearegawi, Berhe; Gomez, Pierre; Jasseh, Momodou; Ansah, Patrick; Debpuur, Cornelius; Oduro, Abraham; Wak, George; Adjei, Alexander; Gyapong, Margaret; Sarpong, Doris; Kant, Shashi; Misra, Puneet; Rai, Sanjay K.; Juvekar, Sanjay; Lele, Pallavi; Bauni, Evasius; Mochamah, George; Ndila, Carolyne; Williams, Thomas N.; Laserson, Kayla F.; Nyaguara, Amek; Odhiambo, Frank O.; Phillips-Howard, Penelope; Ezeh, Alex; Kyobutungi, Catherine; Oti, Samuel; Crampin, Amelia; Nyirenda, Moffat; Price, Alison; Delaunay, Valérie; Diallo, Aldiouma; Douillot, Laetitia; Sokhna, Cheikh; Gómez-Olivé, F. Xavier; Kahn, Kathleen; Tollman, Stephen M.; Herbst, Kobus; Mossong, Joël; Chuc, Nguyen T.K.; Bangha, Martin; Sankoh, Osman A.; Byass, Peter

2014-01-01

Background Mortality from non-communicable diseases (NCDs) is a major global issue, as other categories of mortality have diminished and life expectancy has increased. The World Health Organization's Member States have called for a 25% reduction in premature NCD mortality by 2025, which can only be achieved by substantial reductions in risk factors and improvements in the management of chronic conditions. A high burden of NCD mortality among much older people, who have survived other hazards, is inevitable. The INDEPTH Network collects detailed individual data within defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. Objective To describe patterns of adult NCD mortality from INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories, with separate consideration of premature (15–64 years) and older (65+ years) NCD mortality. Design All adult deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. Results A total of 80,726 adult (over 15 years) deaths were documented over 7,423,497 person-years of observation. NCDs were attributed as the cause for 35.6% of these deaths. Slightly less than half of adult NCD deaths occurred in the 15–64 age group. Detailed results are presented by age and sex for leading causes of NCD mortality. Per-site rates of NCD mortality were significantly correlated with rates of HIV/AIDS-related mortality. Conclusions These findings present important evidence on the distribution of NCD mortality

The relationship between non-communicable disease occurrence and poverty-evidence from demographic surveillance in Matlab, Bangladesh.

PubMed

Mirelman, Andrew J; Rose, Sherri; Khan, Jahangir Am; Ahmed, Sayem; Peters, David H; Niessen, Louis W; Trujillo, Antonio J

2016-07-01

In low-income countries, a growing proportion of the disease burden is attributable to non-communicable diseases (NCDs). There is little knowledge, however, of their impact on wealth, human capital, economic growth or household poverty. This article estimates the risk of being poor after an NCD death in the rural, low-income area of Matlab, Bangladesh. In a matched cohort study, we estimated the 2-year relative risk (RR) of being poor in Matlab households with an NCD death in 2010. Three separate measures of household economic status were used as outcomes: an asset-based index, self-rated household economic condition and total household landholding. Several estimation methods were used including contingency tables, log-binomial regression and regression standardization and machine learning. Households with an NCD death had a large and significant risk of being poor. The unadjusted RR of being poor after death was 1.19, 1.14 and 1.10 for the asset quintile, self-rated condition and landholding outcomes. Adjusting for household and individual level independent variables with log-binomial regression gave RRs of 1.19 [standard error (SE) 0.09], 1.16 (SE 0.07) and 1.14 (SE 0.06), which were found to be exactly the same using regression standardization (SE: 0.09, 0.05, 0.03). Machine learning-based standardization produced slightly smaller RRs though still in the same order of magnitude. The findings show that efforts to address the burden of NCD may also combat household poverty and provide a return beyond improved health. Future work should attempt to disentangle the mechanisms through which economic impacts from an NCD death occur. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Trends and educational differences in non-communicable disease risk factors in Pitkäranta, Russia, from 1992 to 2007.

PubMed

Vlasoff, Tiina; Laatikainen, Tiina; Korpelainen, Vesa; Uhanov, Mihail; Pokusajeva, Svetlana; Tossavainen, Kerttu; Vartiainen, Erkki; Puska, Pekka

2015-02-01

Mortality and morbidity from non-communicable diseases (NCDs) is a major public health problem in Russia. The aim of the study was to examine trends and educational differences from 1992 to 2007 in NCD risk factors in Pitkäranta in the Republic of Karelia, Russia. Four cross-sectional population health surveys were carried out in the Pitkäranta region, Republic of Karelia, Russia, in 1992, 1997, 2002, and 2007. An independent random sample of 1000 persons from the general population aged 25-64 years was studied in each survey round. The total number of respondents in the four surveys was 2672. The surveys included a questionnaire, physical measurements, and blood sampling, and they were carried out following standard protocols. The NCD risk factor trends generally increased in Pitkäranta during the study period with the exception of systolic blood pressure and smoking among men. Especially significant increases were observed in alcohol consumption among both sexes and in smoking among women. Educational differences and differences in trends were relatively small with the exception of a significant increase in smoking in the lowest female educational category. Trends showing an increase in some major NCD risk factors and signs of emerging socio-economic differences call for stronger attention to effective health promotion and preventive policies in Russia. © 2014 the Nordic Societies of Public Health.

Noncommunicable diseases among urban refugees and asylum-seekers in developing countries: a neglected health care need

PubMed Central

2014-01-01

With the increasing trend in refugee urbanisation, growing numbers of refugees are diagnosed with chronic noncommunicable diseases (NCDs). However, with few exceptions, the local and international communities prioritise communicable diseases. The aim of this study is to review the literature to determine the prevalence and distribution of chronic NCDs among urban refugees living in developing countries, to report refugee access to health care for NCDs and to compare the prevalence of NCDs among urban refugees with the prevalence in their home countries. Major search engines and refugee agency websites were systematically searched between June and July 2012 for articles and reports on NCD prevalence among urban refugees. Most studies were conducted in the Middle East and indicated a high prevalence of NCDs among urban refugees in this region, but in general, the prevalence varied by refugees’ region or country of origin. Hypertension, musculoskeletal disease, diabetes and chronic respiratory disease were the major diseases observed. In general, most urban refugees in developing countries have adequate access to primary health care services. Further investigations are needed to document the burden of NCDs among urban refugees and to identify their need for health care in developing countries. PMID:24708876

Health education on diabetes and other non-communicable diseases imparted to teachers shows a cascading effect. A study from Southern India.

PubMed

Selvam, Sundaram; Murugesan, Narayanasamy; Snehalatha, Chamukuttan; Nanditha, Arun; Raghavan, Arun; Simon, Mary; Susairaj, Priscilla; Ramachandran, Ambady

2017-03-01

The aims were to assess effect of a short training programme on non-communicable diseases (NCDs), particularly diabetes on school teachers and also on students who were in turn educated by them. Lifestyle changes made by both groups were assessed 6months later. Graduate teachers (n=1017) from 2 districts in Tamilnadu, India were trained using audio visual aids in batches of 100, on healthy lifestyle practices, prevention and management of diabetes. Pre and post training knowledge scores were assessed using questionnaires. Each teacher was requested to impart similar education to 100 high school students within 3months. Impact of the training on teachers and students was assessed using questionnaires 6months later. Feedback from the students' parents was also collected. A total of 1017 teachers (men: 33.8%, women: 66.2%, urban: 68.8%, rural: 31.1%) were trained. Among them, 651 (men: 31.3%, women: 68.7%) responded for impact evaluation. Changes in knowledge and attitude were reported by 93.7% of teachers. Improvement in lifestyle of the students was assessed by 587 teachers, 60.4% of the students avoided junk foods, 57.5% advised their family members on diabetes. Outdoor games were played by 50.8% of the students. Improvement in knowledge, changes in lifestyle and a positive attitude towards health care delivery were achieved among teachers and students through this training programme. Significant improvement in health perception among the teachers and students occurred even with a short training. It has demonstrated that non-medical personnel like teachers are efficient in disseminating health information on lifestyle diseases especially diabetes. Copyright © 2017 Elsevier B.V. All rights reserved.

Do non-communicable diseases such as hypertension and diabetes associate with primary open-angle glaucoma? Insights from a case-control study in Nepal.

PubMed

Shakya-Vaidya, Suraj; Aryal, Umesh Raj; Upadhyay, Madan; Krettek, Alexandra

2013-11-04

Non-communicable diseases (NCDs) such as hypertension and diabetes are rapidly emerging public health problems worldwide, and they associate with primary open-angle glaucoma (POAG). POAG is the most common cause of irreversible blindness. The most effective ways to prevent glaucoma blindness involve identifying high-risk populations and conducting routine screening for early case detection. This study investigated whether POAG associates with hypertension and diabetes in a Nepalese population. To explore the history of systemic illness, our hospital-based case-control study used non-random consecutive sampling in the general eye clinics in three hospitals across Nepal to enroll patients newly diagnosed with POAG and controls without POAG. The study protocol included history taking, ocular examination, and interviews with 173 POAG cases and 510 controls. Data analysis comprised descriptive and inferential statistics. Descriptive statistics computed the percentage, mean, and standard deviation (SD); inferential statistics used McNemar's test to measure associations between diseases. POAG affected males more frequently than females. The odds of members of the Gurung ethnic group having POAG were 2.05 times higher than for other ethnic groups. Hypertension and diabetes were strongly associated with POAG. The overall odds of POAG increased 2.72-fold among hypertensive and 3.50-fold among diabetic patients. POAG associates significantly with hypertension and diabetes in Nepal. Thus, periodic glaucoma screening for hypertension and diabetes patients in addition to opportunistic screening at eye clinics may aid in detecting more POAG cases at an early stage and hence in reducing avoidable blindness.

Reporting of non-communicable disease research in low- and middle-income countries: a pilot bibliometric analysis*

PubMed Central

Hofman, Karen; Ryce, Andrea; Prudhomme, Wendy; Kotzin, Sheldon

2006-01-01

Objective: The paper identifies the relative amount of research devoted to non-communicable disease in low- and middle-income countries (LMICs). Design: A bibliometric analysis of a subset of journals published in LMICs was performed. Measurements: Seventy-six peer-reviewed journals focused on general medicine or public health published in 46 LMICs and indexed from 1998 to 2003 in MEDLINE. A total of 24 journals were selected, 4 journals from each of 6 LMIC regions. Searches were refined using 18 non-communicable disease topics with 7,012 articles identified for analysis. Results: More than 40% of articles in LMIC regions focused on non-communicable disease research. The percentage was highest in Eastern Europe/Central Asia (47%) and lowest in Latin America (36%). The percentage of articles published in Sub-Saharan Africa (38%) did not differ significantly from that of Latin America or South Asia. Cardiovascular disease and cancer led the list of the top ten most-indexed published topics by region. Conclusions: Even in regions rampant with infectious diseases, some capability exists to conduct research on non-communicable diseases. Greater attention should be paid to the conduct and support of such research in LMICs, which will benefit these countries and may yield clues to lower-cost solutions to the burden of these diseases worldwide. PMID:17082833

Making unhealthy places: The built environment and non-communicable diseases in Khayelitsha, Cape Town.

PubMed

Smit, Warren; de Lannoy, Ariane; Dover, Robert V H; Lambert, Estelle V; Levitt, Naomi; Watson, Vanessa

2016-05-01

In this paper, we examine how economic, social and political forces impact on NCDs in Khayelitsha (a predominantly low income area in Cape Town, South Africa) through their shaping of the built environment. The paper draws on literature reviews and ethnographic fieldwork undertaken in Khayelitsha. The three main pathways through which the built environment of the area impacts on NCDs are through a complex food environment in which it is difficult to achieve food security, an environment that is not conducive to safe physical activity, and high levels of depression and stress (linked to, amongst other factors, poverty, crime and fear of crime). All of these factors are at least partially linked to the isolated, segregated and monofunctional nature of Khayelitsha. The paper highlights that in order to effectively address urban health challenges, we need to understand how economic, social and political forces impact on NCDs through the way they shape built environments. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Disease-specific impoverishment impact of out-of-pocket payments for health care: evidence from rural Bangladesh.

PubMed

Hamid, Syed Abdul; Ahsan, Syed M; Begum, Afroza

2014-08-01

Analysing disease-specific impoverishment impact of out-of-pocket (OOP) payments for health care is crucial for priority setting in any informed policy discussion. Lack of evidence, particularly in the Bangladesh context, motivates our paper. To examine disease-specific impoverishment impact of OOP payments for health care. The paper estimates the poverty impact of OOP payments by comparing the difference between the average level of headcount poverty and poverty gap with and without health care payments. We used primary data drawn from 3,941 households, distributed over 120 villages of seven districts in Bangladesh during August-September 2009. We find that OOP outlays annually push 3.4 % households into poverty. The corresponding figures for those who had non-communicable diseases (NCDs), chronic illness, hospitalization and catastrophic illness were 4.61, 4.65, 14.53 and 17.33 %, respectively. Note that NCDs are the principal reason behind the latter two situations (about 88 % and 85 % of cases, respectively). Looking into individual categories of NCDs we found that major contribution to headcount impoverishment arose out of illnesses such as cholecystectomy, mental disorder, kidney disease, cancer and appendectomy. The intensity of impoverishment is the largest among the hospitalized patients, and more individually among cancer patients. The poverty impact of OOP outlays for health care, in general, is quite high. However, it is especially high for NCDs, particularly for chronic NCDs and those requiring immediate surgical procedures. Hence, these illnesses should be given more priority for policy framing. In addition to suggesting some ex-ante measures (e.g. raising awareness regarding the risk factors causing NCDs), the paper argues for reforms to enhance efficiency in the public health care facilities and increasing the quality of public health care.

Prevalence and care-seeking for chronic diseases among Syrian refugees in Jordan.

PubMed

Doocy, Shannon; Lyles, Emily; Roberton, Timothy; Akhu-Zaheya, Laila; Oweis, Arwa; Burnham, Gilbert

2015-10-31

There are currently more people displaced by conflict than at any time since World War II. The profile of displaced populations has evolved with displacement increasingly occurring in urban and middle-income settings. Consequently, an epidemiological shift away from communicable diseases that have historically characterized refugee populations has occurred. The high prevalence of non-communicable diseases (NCDs) poses a challenge to in terms of provision of appropriate secondary and tertiary services, continuity of care, access to medications, and costs. In light of the increasing burden of NCDs faced by refugees, we undertook this study to characterize the prevalence of NCDs and better understand issues related to care-seeking for NCDs among Syrian refugees in non-camp settings in Jordan. A cross-sectional survey of 1550 refugees was conducted using a multi-stage cluster design with probability proportional to size sampling to obtain a nationally representative sample of Syrian refugees outside of camps. To obtain information on chronic conditions, respondents were asked a series of questions about hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and arthritis. Differences by care-seeking for these conditions were examined using chi-square and t-test methods and characteristics of interest were included in the adjusted logistic regression model. Among adults, hypertension prevalence was the highest (9.7%, CI: 8.8-10.6), followed by arthritis (6.8%, CI: 5.9-7.6), diabetes (5.3%, CI: 4.6-6.0), chronic respiratory diseases (3.1%, CI: 2.4-3.8), and cardiovascular disease (3.7%, CI: 3.2, 4.3). Of the 1363 NCD cases, 84.7% (CI: 81.6-87.3) received care in Jordan; of the five NCDs assessed, arthritis cases had the lowest rates of care seeking at 65%, (CI:0-88, p = 0.005). Individuals from households in which the head completed post-secondary and primary education, respectively, had 89% (CI: 22-98) and 88% (CI: 13-98) lower odds of seeking care

A qualitative study of governance of evolving response to non-communicable diseases in low-and middle- income countries: current status, risks and options

PubMed Central

2012-01-01

Background Segmented service delivery with consequent inefficiencies in health systems was one of the main concerns raised during scaling up of disease-specific programs in the last two decades. The organized response to NCD is in infancy in most LMICs with little evidence on how the response is evolving in terms of institutional arrangements and policy development processes. Methods Drawing on qualitative review of policy and program documents from five LMICs and data from global key-informant surveys conducted in 2004 and 2010, we examine current status of governance of response to NCDs at national level along three dimensions— institutional arrangements for stewardship and program management and implementation; policies/plans; and multisectoral coordination and partnerships. Results Several positive trends were noted in the organization and governance of response to NCDs: shift from specific NCD-based programs to integrated NCD programs, increasing inclusion of NCDs in sector-wide health plans, and establishment of high-level multisectoral coordination mechanisms. Several areas of concern were identified. The evolving NCD-specific institutional structures are being treated as ‘program management and implementation’ entities rather than as lead ‘technical advisory’ bodies, with unclear division of roles and responsibilities between NCD-specific and sector-wide structures. NCD-specific and sector-wide plans are poorly aligned and lack prioritization, costing, and appropriate targets. Finally, the effectiveness of existing multisectoral coordination mechanisms remains questionable. Conclusions The ‘technical functions’ and ‘implementation and management functions’ should be clearly separated between NCD-specific units and sector-wide institutional structures to avoid duplicative segmented service delivery systems. Institutional capacity building efforts for NCDs should target both NCD-specific units (for building technical and analytical capacity

The Development of Public Policies to Address Non-communicable Diseases in the Caribbean Country of Barbados: The Importance of Problem Framing and Policy Entrepreneurs.

PubMed

Unwin, Nigel; Samuels, T Alafia; Hassell, Trevor; Brownson, Ross C; Guell, Cornelia

2016-06-15

Government policy measures have a key role to play in the prevention and control of non-communicable diseases (NCDs). The Caribbean, a middle-income region, has the highest per capita burden of NCDs in the Americas. Our aim was to examine policy development and implementation between the years 2000 and 2013 on NCD prevention and control in Barbados, and to investigate factors promoting, and hindering, success. A qualitative case study design was used involving a structured policy document review and semi-structured interviews with key informants, identified through stakeholder analysis and 'cascading.' Documents were abstracted into a standard form. Interviews were recorded, transcribed verbatim and underwent framework analysis, guided by the multiple streams framework (MSF). There were 25 key informants, from the Ministry of Health (MoH), other government Ministries, civil society organisations, and the private sector. A significant policy window opened between 2005 and 2007 in which new posts to address NCDs were created in the MoH, and a government supported multi-sectoral national NCD commission was established. Factors contributing to this government commitment and funding included a high level of awareness, throughout society, of the NCD burden, including media coverage of local research findings; the availability of policy recommendations by international bodies that could be adopted locally, notably the framework convention on tobacco control (FCTC); and the activities of local highly respected policy entrepreneurs with access to senior politicians, who were able to bring together political concern for the problem with potential policy solutions. However, factors were also identified that hindered multi-sectoral policy development in several areas, including around nutrition, physical activity, and alcohol. These included a lack of consensus (valence) on the nature of the problem, often framed as being predominantly one of individuals needing to take

Reducing Disaster Exacerbated Non-Communicable Diseases Through Public Health Infrastructure Resilience: Perspectives of Australian Disaster Service Providers

PubMed Central

Ryan, Benjamin J.; Franklin, Richard C.; Burkle Jr., Frederick M.; Aitken, Peter; Smith, Erin; Watt, Kerrianne; Leggat, Peter

2016-01-01

Background: The exposure of people and infrastructure to flood and storm related disasters across the world is increasing faster than vulnerability is decreasing. For people with non-communicable diseases this presents a significant risk as traditionally the focus of disaster management systems has been on immediate trauma and communicable diseases. This focus must now be expanded to include the management of non-communicable diseases because these conditions are generating the bulk of ill health, disability and premature death around the globe. When public health service infrastructure is destroyed or damaged access to treatment and care is severely jeopardised, resulting in an increased risk of non-communicable disease exacerbation or even death. This research proposes disaster responders, coordinators and government officials are vital assets to mitigate and eventually prevent these problems from being exacerbated during a disaster. This is due to their role in supporting the public health service infrastructure required to maximise treatment and care for people with non-communicable diseases. By focusing on the disaster cycle as a template, and on mitigation and prevention phases in particular, these actions and activities performed by disaster service responders will lead to overall improved preparedness, response, recovery and rehabilitation phases. Methods: Data were collected via 32 interviews and one focus group (eight participants) between March 2014 and August 2015 (total of 40 participants). The research was conducted in the State of Queensland, Australia, with disaster service providers. The analysis included the phases of: organizing data; data description; data classification; and interpretation. Results: The research found a relationship between the impact of a disaster on public health service infrastructure, and increased health risks for people with non-communicable diseases. Mitigation strategies were described for all phases of the disaster

Reducing Disaster Exacerbated Non-Communicable Diseases Through Public Health Infrastructure Resilience: Perspectives of Australian Disaster Service Providers.

PubMed

Ryan, Benjamin J; Franklin, Richard C; Burkle, Frederick M; Aitken, Peter; Smith, Erin; Watt, Kerrianne; Leggat, Peter

2016-12-21

The exposure of people and infrastructure to flood and storm related disasters across the world is increasing faster than vulnerability is decreasing. For people with non-communicable diseases this presents a significant risk as traditionally the focus of disaster management systems has been on immediate trauma and communicable diseases. This focus must now be expanded to include the management of non-communicable diseases because these conditions are generating the bulk of ill health, disability and premature death around the globe. When public health service infrastructure is destroyed or damaged access to treatment and care is severely jeopardised, resulting in an increased risk of non-communicable disease exacerbation or even death. This research proposes disaster responders, coordinators and government officials are vital assets to mitigate and eventually prevent these problems from being exacerbated during a disaster. This is due to their role in supporting the public health service infrastructure required to maximise treatment and care for people with non-communicable diseases. By focusing on the disaster cycle as a template, and on mitigation and prevention phases in particular, these actions and activities performed by disaster service responders will lead to overall improved preparedness, response, recovery and rehabilitation phases. Data were collected via 32 interviews and one focus group (eight participants) between March 2014 and August 2015 (total of 40 participants). The research was conducted in the State of Queensland, Australia, with disaster service providers. The analysis included the phases of: organizing data; data description; data classification; and interpretation. The research found a relationship between the impact of a disaster on public health service infrastructure, and increased health risks for people with non-communicable diseases. Mitigation strategies were described for all phases of the disaster cycle impacting public health

Systems medicine and integrated care to combat chronic noncommunicable diseases

PubMed Central

2011-01-01

We propose an innovative, integrated, cost-effective health system to combat major non-communicable diseases (NCDs), including cardiovascular, chronic respiratory, metabolic, rheumatologic and neurologic disorders and cancers, which together are the predominant health problem of the 21st century. This proposed holistic strategy involves comprehensive patient-centered integrated care and multi-scale, multi-modal and multi-level systems approaches to tackle NCDs as a common group of diseases. Rather than studying each disease individually, it will take into account their intertwined gene-environment, socio-economic interactions and co-morbidities that lead to individual-specific complex phenotypes. It will implement a road map for predictive, preventive, personalized and participatory (P4) medicine based on a robust and extensive knowledge management infrastructure that contains individual patient information. It will be supported by strategic partnerships involving all stakeholders, including general practitioners associated with patient-centered care. This systems medicine strategy, which will take a holistic approach to disease, is designed to allow the results to be used globally, taking into account the needs and specificities of local economies and health systems. PMID:21745417

Early-Life Nutritional Programming of Health and Disease in The Gambia.

PubMed

Moore, Sophie E

2017-01-01

Exposures during early life are increasingly being recognised as factors that play an important role in the aetiology of chronic non-communicable diseases (NCDs). The "Developmental Origins of Health and Disease" (DOHaD) hypothesis asserts that adverse early-life exposures - most notably unbalanced nutrition - leads to an increased risk for a range of NCDs and that disease risk is highest when there is a "mismatch" between the early- and later-life environments. Thus, the DOHaD hypothesis would predict highest risk in settings undergoing a rapid nutrition transition. We investigated the link between early-life nutritional exposures and long-term health in rural Gambia, West Africa. Using demographic data dating back to the 1940s, the follow-up of randomised controlled trials of nutritional supplementation in pregnancy, and the "experiment of nature" that seasonality in this region provides, we investigated the DOHaD hypothesis in a population with high rates of maternal and infant under-nutrition, a high burden from infectious disease, and an emerging risk of NCDs. Key Messages: Our work in rural Gambia suggests that in populations with high rates of under-nutrition in early life, the immune system may be sensitive to nutritional deficiencies early in life, resulting in a greater susceptibility to infection-related morbidity and mortality. © 2017 S. Karger AG, Basel.

Sociodemographic and socioeconomic patterns of chronic non-communicable disease among the older adult population in Ghana.

PubMed

Minicuci, Nadia; Biritwum, Richard B; Mensah, George; Yawson, Alfred E; Naidoo, Nirmala; Chatterji, Somnath; Kowal, Paul

2014-01-01

In Ghana, the older adult population is projected to increase from 5.3% of the total population in 2015 to 8.9% by 2050. National and local governments will need information about non-communicable diseases (NCDs) in this population in order to allocate health system resources and respond to the health needs of older adults. The 2007/08 Study on global AGEing and adult health (SAGE) Wave 1 in Ghana used face-to-face interviews in a nationally representative sample of persons aged 50-plus years. Individual respondents were asked about their overall health, diagnosis of 10 chronic non-communicable conditions, and common health risk factors. A number of anthropometric and health measurements were also taken in all respondents, including height, weight, waist and hip circumferences, and blood pressure (BP). This paper includes 4,724 adults aged 50-plus years. The highest prevalence of self-reported chronic conditions was for hypertension [14.2% (95% CI 12.8-15.6)] and osteoarthritis [13.8%, (95% CI 11.7-15.9)]. The figure for hypertension reached 51.1% (95% CI 48.9-53.4) when based on BP measurement. The prevalence of current smokers was 8.1% (95% CI 7.0-9.2), while 2.0 (95% CI 1.5-2.5) were infrequent/frequent heavy drinkers, 67.9% (95% CI 65.2-70.5) consume insufficient fruits and vegetables, and 25.7% (95% CI 23.1-28.3) had a low level of physical activity. Almost 10% (95% CI 8.3-11.1) of adults were obese and 77.6% (95% CI 76.0-79.2) had a high-risk waist-to-hip ratio (WHR). Risks from tobacco and alcohol consumption continued into older age, while insufficient fruit and vegetable intake, low physical activity and obesity increased with increasing age. The patterns of risk factors varied by income quintile, with higher prevalence of obesity and low physical activity in wealthier respondents, and higher prevalence of insufficient fruit and vegetable intake and smoking in lower-income respondents. The multivariate analysis showed that only urban/rural residence and

Sociodemographic and socioeconomic patterns of chronic non-communicable disease among the older adult population in Ghana

PubMed Central

Minicuci, Nadia; Biritwum, Richard B.; Mensah, George; Yawson, Alfred E.; Naidoo, Nirmala; Chatterji, Somnath; Kowal, Paul

2014-01-01

Background In Ghana, the older adult population is projected to increase from 5.3% of the total population in 2015 to 8.9% by 2050. National and local governments will need information about non-communicable diseases (NCDs) in this population in order to allocate health system resources and respond to the health needs of older adults. Design The 2007/08 Study on global AGEing and adult health (SAGE) Wave 1 in Ghana used face-to-face interviews in a nationally representative sample of persons aged 50-plus years. Individual respondents were asked about their overall health, diagnosis of 10 chronic non-communicable conditions, and common health risk factors. A number of anthropometric and health measurements were also taken in all respondents, including height, weight, waist and hip circumferences, and blood pressure (BP). Results This paper includes 4,724 adults aged 50-plus years. The highest prevalence of self-reported chronic conditions was for hypertension [14.2% (95% CI 12.8–15.6)] and osteoarthritis [13.8%, (95% CI 11.7–15.9)]. The figure for hypertension reached 51.1% (95% CI 48.9–53.4) when based on BP measurement. The prevalence of current smokers was 8.1% (95% CI 7.0–9.2), while 2.0 (95% CI 1.5–2.5) were infrequent/frequent heavy drinkers, 67.9% (95% CI 65.2–70.5) consume insufficient fruits and vegetables, and 25.7% (95% CI 23.1–28.3) had a low level of physical activity. Almost 10% (95% CI 8.3–11.1) of adults were obese and 77.6% (95% CI 76.0–79.2) had a high-risk waist-to-hip ratio (WHR). Risks from tobacco and alcohol consumption continued into older age, while insufficient fruit and vegetable intake, low physical activity and obesity increased with increasing age. The patterns of risk factors varied by income quintile, with higher prevalence of obesity and low physical activity in wealthier respondents, and higher prevalence of insufficient fruit and vegetable intake and smoking in lower-income respondents. The multivariate analysis

Cost and affordability of non-communicable disease screening, diagnosis and treatment in Kenya: Patient payments in the private and public sectors

PubMed Central

Gakunga, Robai; Kibachio, Joseph; Gathecha, Gladwell; Edwards, Patrick; Ogola, Elijah; Yonga, Gerald; Busakhala, Naftali; Munyoro, Esther; Chakaya, Jeremiah; Ngugi, Nancy; Mwangi, Nyawira; Von Rege, Daniel; Wangari, Lili-Marie; Wata, David; Makori, Robert; Mwangi, Julius; Mwanda, Walter

2018-01-01

Introduction The prevalence of non-communicable diseases (NCDs) is rising in low- and middle-income countries, including Kenya, disproportionately to the rest of the world. Our objective was to quantify patient payments to obtain NCD screening, diagnosis, and treatment services in the public and private sector in Kenya and evaluate patients’ ability to pay for the services. Methods and findings We collected payment data on cardiovascular diseases, diabetes, breast and cervical cancer, and respiratory diseases from Kenyatta National Hospital, the main tertiary public hospital, and the Kibera South Health Center—a public outpatient facility, and private sector practitioners and hospitals. We developed detailed treatment frameworks for each NCD and used an itemization cost approach to estimate payments. Patient affordability metrics were derived from Kenyan government surveys and national datasets. Results compare public and private costs in U.S. dollars. NCD screening costs ranged from $4 to $36, while diagnostic procedures, particularly for breast and cervical cancer, were substantially more expensive. Annual hypertension medication costs ranged from $26 to $234 and $418 to $987 in public and private facilities, respectively. Stroke admissions ($1,874 versus $16,711) and dialysis for chronic kidney disease ($5,338 versus $11,024) were among the most expensive treatments. Cervical and breast cancer treatment cost for stage III (curative approach) was about $1,500 in public facilities and more than $7,500 in the private facilities. A large proportion of Kenyans aged 15 to 49 years do not have health insurance, which makes NCD services unaffordable for most people given the overall high cost of services relative to income (average household expenditure per adult is $413 per annum). Conclusions There is substantial variation in patient costs between the public and private sectors. Most NCD diagnosis and treatment costs, even in the public sector, represent a

Exercise physiologists emerge as allied healthcare professionals in the era of non-communicable disease pandemics: a report from Australia, 2006-2012.

PubMed

Cheema, Birinder S; Robergs, Robert A; Askew, Christopher D

2014-07-01

Exercise can be prescribed to prevent, manage, and treat many leading non-communicable diseases (NCDs) and underlying risk factors. However, surprisingly, Australia is one of only a few countries where allied healthcare professionals with specialized university education and training in exercise prescription and delivery provide services within a government-run healthcare system (Medicare). This article presents data on Medicare-funded services provided by accredited exercise physiologists (AEPs) from the inclusion of the profession in the allied healthcare model (January, 2006) to the end of 2012. We conceptualize these data in relation to current NCD trends, and outline recommendations that can potentially help curtail the current chronic disease burden through the further integration of exercise professionals into the healthcare system in Australia, and internationally. From 2006 to 2012, the number of AEPs in Australia has increased 563 %. This rise in AEPs has been paralleled by increased delivery of services for eligible patients with a chronic medical condition (+614 %), type 2 diabetes mellitus (+211 to 230 %), and of Aboriginal and Torres Strait Islander descent (+343 %). These trends, which were developed through the "early years" of the profession, are encouraging and suggest that AEPs have taken up a vital position within the healthcare system. However, the total number of services provided by AEPs currently remains very low in relation to the prevalence of overweight-obesity and type 2 diabetes in Australia. Furthermore, services for Aboriginal Australians are very low considering the extreme burden of chronic diseases in these vulnerable populations. We provide some recommendations that may help the exercise physiology profession play a greater role in tackling the NCD burden and shift the healthcare model in a direction that is more proactive and focused on disease prevention and health, including the early identification and treatment of major

Protecting children and families from tobacco and tobacco-related NCDs in the Western Pacific: good practice examples from Malaysia, Philippines and Singapore.

PubMed

David, A M; Mercado, S P; Klein, J D; Kaundan, M s/o K; Koong, H N; Garcia, E

2017-09-01

Non-communicable diseases (NCDs) are generally considered diseases of adulthood, but NCD risk factors like tobacco use often are taken up during childhood and adolescence, and second-hand smoke exposure affects child survival and development. At a regional meeting of the Asia Pacific Child and Family Health Alliance for Tobacco Control, members reviewed existing good practices of child-focused tobacco control approaches using health promotion strategies. These interventions were implemented nationally in Malaysia, the Philippines and Singapore. Three good practice national examples were identified that focused on creating supportive tobacco-free environments and upgrading cessation skills among paediatricians. These country examples highlight strategic areas to protect children and families from the harms of tobacco, as part of NCD prevention and control. Training paediatricians in brief cessation advice has enabled them to address tobacco-using parents. Fully enforcing smoke-free public areas has led to an increase in smoke-free homes. The Tobacco Free Generation is a tobacco control 'endgame' strategy that taps into a social movement to deglamorize tobacco use and empower youth born in and after year 2000 to reject tobacco and nicotine addiction. Tobacco control is pivotal in the fight against NCDs; health promotion strategies to protect children and youth from tobacco have a critical role to play in NCD prevention and control. Frontline health workers, including primary care paediatricians, need to step up and actively advocate for full implementation of the WHO Framework Convention on Tobacco Control, including tobacco tax increases and smoke-free areas, while monitoring patients and their parents for tobacco use and second-hand smoke exposure, preventing adolescent smoking uptake, and offering cessation support. A life-course approach incorporating child-focused efforts to prevent initiation of smoking and second-hand smoke exposure with measures promoting

Challenges for clinical practice and research in family medicine in reducing the risk of chronic diseases. Notes on the EGPRN Spring Conference 2017 in Riga

PubMed Central

Silina, Vija; Kalda, Ruth

2018-01-01

Abstract Chronic diseases in most cases belong to the category of non-communicable diseases (NCDs), which are the main cause of mortality globally. Cardiovascular diseases, diabetes, chronic obstructive pulmonary disease and cancer are the four NCDs responsible for 82% of NCD deaths. Prevention of NCDs implies health promotion activities that encourage healthy lifestyle and limit the initial onset of chronic diseases. Prevention also includes early detection activities, such as screening at-risk populations, as well as strategies for appropriate management of existing diseases and related complications. Early intervention, reducing morbidity and mortality rates could be an appealing idea for patients, physicians and governmental institutions but could also cause harm. Healthcare is undergoing profound changes, and the role of technology in diagnostics and management of chronic diseases in primary healthcare (PHC) is increasing remarkably. However, studies show that the standards of care for chronic diseases and preventive care are met by less than 50%. We still lack clear standards for patients with multiple chronic diseases. The applicability of a single evidence-based guideline to multimorbid patients is limited and can be problematic. Well-designed PHC studies focusing on the impact of medical interventions on morbidity, mortality and quality of life in the fields of early diagnosis, early treatment and multimorbidity are still needed. PMID:29393709

Challenges for clinical practice and research in family medicine in reducing the risk of chronic diseases. Notes on the EGPRN Spring Conference 2017 in Riga.

PubMed

Silina, Vija; Kalda, Ruth

2018-12-01

Chronic diseases in most cases belong to the category of non-communicable diseases (NCDs), which are the main cause of mortality globally. Cardiovascular diseases, diabetes, chronic obstructive pulmonary disease and cancer are the four NCDs responsible for 82% of NCD deaths. Prevention of NCDs implies health promotion activities that encourage healthy lifestyle and limit the initial onset of chronic diseases. Prevention also includes early detection activities, such as screening at-risk populations, as well as strategies for appropriate management of existing diseases and related complications. Early intervention, reducing morbidity and mortality rates could be an appealing idea for patients, physicians and governmental institutions but could also cause harm. Healthcare is undergoing profound changes, and the role of technology in diagnostics and management of chronic diseases in primary healthcare (PHC) is increasing remarkably. However, studies show that the standards of care for chronic diseases and preventive care are met by less than 50%. We still lack clear standards for patients with multiple chronic diseases. The applicability of a single evidence-based guideline to multimorbid patients is limited and can be problematic. Well-designed PHC studies focusing on the impact of medical interventions on morbidity, mortality and quality of life in the fields of early diagnosis, early treatment and multimorbidity are still needed.

Disease and age pattern of hospitalisation and associated costs in India: 1995-2014.

PubMed

Kastor, Anshul; Mohanty, Sanjay K

2018-01-24

The prime objective of this study is to examine the trends of disease and age pattern of hospitalisation and associated costs in India during 1995-2014. Present study used nationally representative data on morbidity and healthcare from the 52nd (1995) and 71st (2014) rounds of the National Sample Survey. A total of 120 942 and 65 932 households were surveyed in 1995 and 2014, respectively. Descriptive statistics, logistic regression analyses and decomposition analyses were used in examining the changes in patterns of hospitalisation and associated costs. Hospitalisation rates and costs per hospitalisation (out-of-pocket expenditure) were estimated for selected diseases and in four broad categories: communicable diseases, non-communicable diseases (NCDs), injuries and others. All the costs are presented at 2014 prices in US$. Hospitalisation rate in India has increased from 1661 in 1995 to 3699 in 2014 (per 100 000 population). It has more than doubled across all age groups. Hospitalisation among children was primarily because of communicable diseases, while NCDs were the leading cause of hospitalisation for the 40+ population. Costs per hospitalisation have increased from US$177 in 1995 to US$316 in 2014 (an increase of 79%). Costs per hospitalisation for NCDs in 2014 were US$471 compared with US$175 for communicable diseases. It was highest for cancer inpatients (US$942) followed by heart diseases (US$674). Age is the significant predictor of hospitalisation for all the selected diseases. Decomposition results showed that about three-fifth of the increase in unconditional costs per hospitalisation was due to increase in mean hospital costs, and the other two-fifth was due to increase in hospitalisation rates. There has been more than twofold increase in hospitalisation rates in India during the last two decades, and significantly higher rates were observed among infants and older adults. Increasing hospitalisation rates and costs per hospitalisation are

Commentary on a meeting entitled 'Building global capacity for non-communicable diseases (NCD) prevention: Defining direction and roles'.

PubMed

McQueen, David; Pratt, Michael; Blanchard, Claire

2013-12-01

This Commentary summarizes the key points that arose during a three-day meeting held in Atlanta in July 2012 on Building Global Capacity for NCD Prevention. A wide spectrum of participants representing many sectors of global health, including ministries of health from several low and middle-income countries (LMICs), governmental institutions, non-governmental organizations, national disease associations, academia, and global and regional institutions participated. Presentations and group discussions led to agreement on a number of actions that should be taken to increase capacity for coping with NCDs in LMICs. Key areas of discussion were on the role of research, workforce development, resources, and governance. While there was considerable agreement on what should be done, the workshop participants had difficulty in prioritizing these activities. This led to an agreement by the gathered participants that a follow-up Delphi study be conducted to help with prioritization.

[Study on health support strategies by analyzing the diet, alcohol intake, and smoking behavior of university students: examination of non-communicable disease risk factors according to their sex, age and living arrangement].

PubMed

Kasamaki, Junichi

2015-01-01

The purpose of this study was to understand the diet, drinking, and smoking behaviors of university students and to analyze the health behaviors that could be a risk factor for non-communicable diseases (NCDs) in order to contribute to the promotion of NCD prevention in youth. The survey was carried out using a questionnaire with closed questions including items about health behaviors. The subjects surveyed were students of 10 universities on the main island of Japan (1,196 valid responders). The score for the nutritional balance was significantly low in the group living alone for both students in their teens and 20s. For the frequency of not eating breakfast, results suggest that living alone and increase in age are related to the lack of breakfast for both males and females. Teenage males living alone tended to lack in consideration for the intake of animal fat than those not living alone. The females showed a higher tendency to eat sweets and snacks during the day than the males. For the males who living alone, results suggest that they tended to have a higher or equal alcohol intake to females in their 20s and males in their 20s not living alone even when they are underage. Males in their 20s tended to have a higher amount and frequency of smoking than other groups regardless of their living arrangement. Accumulation of health behavior that could be a risk for NCDs was found in some of the groups, such as males living alone.

Can the rural poor in India afford to treat non-communicable diseases.

PubMed

Binnendijk, Erika; Koren, Ruth; Dror, David M

2012-11-01

Non-communicable diseases (NCD) are on the increase in low-income countries, where healthcare costs are paid mostly out-of-pocket. We investigate the financial burden of NCD vs. communicable diseases (CD) among rural poor in India and assess whether they can afford to treat NCD. We used data from two household surveys undertaken in 2009-2010 among 7389 rural poor households (39 205 individuals) in Odisha and Bihar. All persons from the sampled households, irrespective of age and gender, were included in the analysis. We classify self-reported illnesses as NCD, CD or 'other morbidities' following the WHO classification. Non-communicable diseases accounted for around 20% of the diseases in the month preceding the survey in Odisha and 30% in Bihar. The most prevalent NCD, representing the highest share in outpatient costs, were musculoskeletal, digestive and cardiovascular diseases. Cardiovascular and digestive problems also generated the highest inpatient costs. Women, older persons and less-poor households reported higher prevalence of NCD. Outpatient costs (consultations, medicines, laboratory tests and imaging) represented a bigger share of income for NCD than for CD. Patients with NCD were more likely to report a hospitalisation. Patients with NCD in rural poor settings in India pay considerably more than patients with CD. For NCD cases that are chronic, with recurring costs, this would be aggravated. The cost of NCD care consumes a big part of the per person share of household income, obliging patients with NCD to rely on informal intra-family cross-subsidisation. An alternative solution to finance NCD care for rural poor patients is needed. © 2012 Blackwell Publishing Ltd.

Neglected chronic disease: The WHO framework on non-communicable diseases and implications for the global poor.

PubMed

Nulu, Shanti

2017-04-01

The current global framework on noncommunicable disease (NCD), as exemplified by the WHO Action Plan of 2012, neglects the needs of the global poor. The current framework is rooted in an outdated pseudo-evolutionary theory of epidemiologic transition, which weds NCDs to modernity, and relies on global aggregate data. It is oriented around a simplistic causal model of behaviour, risk and disease, which implicitly locates 'risk' within individuals, conveniently drawing attention away from important global drivers of the NCD epidemic. In fact, the epidemiologic realities of the bottom billion reveal a burden of neglected chronic diseases that are associated with 'alternative' environmental and infectious risks that are largely structurally determined. In addition, the vertical orientation of the framework fails to centralise health systems and delivery issues that are essential to chronic disease prevention and treatment. A new framework oriented around a global health equity perspective would be able to correct some of the failures of the current model by bringing the needs of the global poor to the forefront, and centralising health systems and delivery. In addition, core social science concepts such as Bordieu's habitus may be useful to re-conceptualising strategies that may address both behavioural and structural determinants of health.

[Factors associated to mortality by non-communicable diseases in Colombia, 2008-2012].

PubMed

Martínez, Julio Cesar

2016-12-01

Non-communicable diseases are the leading cause of premature mortality and disability in the world. To describe the trend pattern and to explore which risk factors were associated with mortality rates in Colombia from 2008 to 2012. A descriptive study was conducted to analyze mortality rate trends from the official vital statistics (death certificates) from 2008 to 2012. Between 2008 and 2012 there were 727,146 deaths due to non-communicable diseases, and 58.5% of them occurred among men aged less than 75 years. The mortality rate during the study period was 319.5 deaths per 100,000 people. The trend showed a statistically significant decline in mortality rates (-3%) across the country. For each woman who died due to external causes (i.e., not related to illness or old age), five men died under the same circumstances (OR=5,295; IC 95%: 5,143-5,454). The five most important causes of mortality were heart diseases, injuries due to aggressions, malignant tumors, chronic lower respiratory diseases and road traffic accidents. The cause of death differed significantly by sex and age. The main causes of death in Colombia were heart diseases and injuries (homicide). Mortality was higher among men of all ages than among women, but 15 to 45 year-old males were more likely to die due to external causes.

Risk factor profile for non-communicable diseases among Mishing tribes in Assam, India: results from a WHO STEPs survey.

PubMed

Misra, Palash Jyoti; Mini, G K; Thankappan, K R

2014-09-01

A comprehensive risk factor profile of non-communicable diseases (NCDs) as suggested by the World Health Organization (WHO) has not been reported from tribal population in India. This survey was carried out to assess the prevalence of NCD risk factors among Mishing tribes in Assam using the WHO STEPs approach. A total of 332 individuals of the Mishing tribe (men 54%) aged 25-64 yr were selected from Tinsukia district by multistage cluster sampling. Using the WHO STEPs approach information was collected on demographics, STEP 1 variables (tobacco, alcohol, physical activity, diet) and measured STEP 2 variables (weight, height, waist circumference and blood pressure). Multivariate analysis was used to find the relation between STEP 1 and STEP 2 variables. Overall, tobacco use was 84 per cent (men 94%; women 73%, p0 <0.001) and alcohol use was 67 per cent (men 82%; women 50%, p0 <0.05); 86 per cent reported vigorous physical activity, (men 91%, women 82%; p0 < 0.05). Sixty eight per cent reported to consume unhealthy diet (less than five servings of fruits and vegetables/day), 11 per cent had abdominal obesity, 16 per cent were overweight and 26 per cent had hypertension. Non users of tobacco and those who consumed more fruits and vegetables had higher prevalence of overweight ( p0 <0.05). Among the hypertensives, 24 per cent were aware, 17 per cent treated and 2.4 per cent controlled their hypertension. Older individuals had higher hypertension prevalence ( p0 <0.05) compared to younger individuals. Tobacco use, alcohol use and unhealthy diet habits were high among men and women in this population and were major NCD risk factors. An integrated approach of culturally appropriate population level and high risk strategies are warranted to reduce these risk factors and to enhance adequate control of hypertension.

Risk factor profile for non-communicable diseases among Mishing tribes in Assam, India: Results from a WHO STEPs survey

PubMed Central

Misra, Palash Jyoti; Mini, G.K.; Thankappan, K.R.

2014-01-01

Background & objectives: A comprehensive risk factor profile of non-communicable diseases (NCDs) as suggested by the World Health Organization (WHO) has not been reported from tribal population in India. This survey was carried out to assess the prevalence of NCD risk factors among Mishing tribes in Assam using the WHO STEPs approach. Methods: A total of 332 individuals of the Mishing tribe (men 54%) aged 25-64 yr were selected from Tinsukia district by multistage cluster sampling. Using the WHO STEPs approach information was collected on demographics, STEP 1 variables (tobacco, alcohol, physical activity, diet) and measured STEP 2 variables (weight, height, waist circumference and blood pressure). Multivariate analysis was used to find the relation between STEP 1 and STEP 2 variables. Results: Overall, tobacco use was 84 per cent (men 94%; women 73%, P<0.001) and alcohol use was 67 per cent (men 82%; women 50%, P<0.05); 86 per cent reported vigorous physical activity, (men 91%, women 82%; P < 0.05). Sixty eight per cent reported to consume unhealthy diet (less than five servings of fruits and vegetables/day), 11 per cent had abdominal obesity, 16 per cent were overweight and 26 per cent had hypertension. Non users of tobacco and those who consumed more fruits and vegetables had higher prevalence of overweight (P<0.05). Among the hypertensives, 24 per cent were aware, 17 per cent treated and 2.4 per cent controlled their hypertension. Older individuals had higher hypertension prevalence (P<0.05) compared to younger individuals. Interpretation & conclusions: Tobacco use, alcohol use and unhealthy diet habits were high among men and women in this population and were major NCD risk factors. An integrated approach of culturally appropriate population level and high risk strategies are warranted to reduce these risk factors and to enhance adequate control of hypertension. PMID:25366204

An integrated approach to telemonitoring noncommunicable diseases: best practice from the European innovation partnership on active and healthy ageing.

PubMed

Bourret, Rodolphe; Bousquet, Jean

2013-01-01

The European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) has prioritized noncommunicable diseases (NCDs). An innovative integrated health system built around medical systems and strategic partnerships is proposed to combat NCDs. Information and communication technology (ICT) is needed for the implementation of integrated care in a medical systems approach. The Teaching Hospital of Montpellier has set up the clinic and uses IP-Soins as an ICT tool. Patients with NCDs will be referred to the chronic disease clinic of the hospital by a primary care physician. This paper reviews the complexity of NCDs intertwined with ageing. It gives an overview of the problem. It presents an innovative approach in the implementation of a clinical information system in a "SaaS" (Software as a Service) mode.

[Study on the effectiveness of implementation: the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases].

PubMed

Zhang, J; Jin, R R; Li, J J; Li, J L; Su, X W; Deng, G J; Ma, S; Zhao, J; Wang, Y P; Bian, F; Qu, Y M; Shen, Z Z; Jiang, Y; Liu, Y L

2018-04-10

Objective: To assess the implementation and impact of programs carried out by the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases. Methods: Both sociological and epidemiological methods were used to collect qualitative and quantitative data in November and December, 2016 in order to conduct on process and outcome evaluation of the above mentioned objective. In the meantime, case study was also conducted. Results: All the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases were found well implemented across the country, with health education and health promotion, surveillance and safeguard measures in particular. A government-led and inter-sector coordination and communication mechanism had been well established, with more than 16 non-health departments actively involved. 28.7% of the residents living in the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases were aware of the key messages related to chronic diseases. Among the residents, 72.1% of them consumed vegetables and 53.6% consumed fruits daily, with another 86.9% walked at least 10 minutes per day. Over 70% of the patients with hypertension or diabetes reported that they were taken care of by the Community Health Centers, and above 50% of them were under standardized management. Residents, living in the National Demonstration Areas under higher ranking of implementation scores, were more likely to be aware of relevant knowledge on chronic disease control and prevention ( OR =6.591, 95% CI : 5.188-8.373), salt reduction ( OR =1.352, 95% CI : 1.151-1.589), oil reduction ( OR =1.477, 95% CI : 1.249-1.746) and recommendation on physical activities ( OR =1.975, 95% CI : 1.623- 2.403). Conclusion: The implementation of programs carried out by the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases had served a local

Analyzing the impact of severe tropical cyclone Yasi on public health infrastructure and the management of noncommunicable diseases.

PubMed

Ryan, Benjamin J; Franklin, Richard C; Burkle, Frederick M; Watt, Kerrianne; Aitken, Peter; Smith, Erin C; Leggat, Peter

2015-02-01

Traditionally, post disaster response activities have focused on immediate trauma and communicable diseases. In developed countries such as Australia, the post disaster risk for communicable disease is low. However, a "disease transition" is now recognized at the population level where noncommunicable diseases (NCDs) are increasingly documented as a post disaster issue. This potentially places an extra burden on health care resources and may have implications for disaster-management systems. With increasing likelihood of major disasters for all sectors of global society, there is a need to ensure that health systems, including public health infrastructure (PHI), can respond properly. Problem There is limited peer-reviewed literature on the impact of disasters on NCDs. Research is required to better determine both the impact of NCDs post disaster and their impact on PHI and disaster-management systems. A literature review was used to collect and analyze data on the impact of the index case event, Australia's Severe Tropical Cyclone Yasi (STC Yasi), on PHI and the management of NCDs. The findings were compared with data from other world cyclone events. The databases searched were MEDLINE, CINAHL, Google Scholar, and Google. The date range for the STC Yasi search was January 26, 2011 through May 2, 2013. No time limits were applied to the search from other cyclone events. The variables compared were tropical cyclones and their impacts on PHI and NCDs. The outcome of interest was to identify if there were trends across similar world events and to determine if this could be extrapolated for future crises. This research showed a tropical cyclone (including a hurricane and typhoon) can impact PHI, for instance, equipment (oxygen, syringes, and medications), services (treatment and care), and clean water availability/access that would impact both the treatment and management of NCDs. The comparison between STC Yasi and worldwide tropical cyclones found the challenges faced

Health policy for sickle cell disease in Africa: experience from Tanzania on interventions to reduce under-five mortality.

PubMed

Makani, Julie; Soka, Deogratias; Rwezaula, Stella; Krag, Marlene; Mghamba, Janneth; Ramaiya, Kaushik; Cox, Sharon E; Grosse, Scott D

2015-02-01

Tanzania has made considerable progress towards reducing childhood mortality, achieving a 57% decrease between 1980 and 2011. This epidemiological transition will cause a reduction in the contribution of infectious diseases to childhood mortality and increase in contribution from non-communicable diseases (NCDs). Haemoglobinopathies are amongst the most common childhood NCDs, with sickle cell disease (SCD) being the commonest haemoglobinopathy in Africa. In Tanzania, 10,313 children with SCD under 5 years of age (U5) are estimated to die every year, contributing an estimated 7% of overall deaths in U5 children. Key policies that governments in Africa are able to implement would reduce mortality in SCD, focusing on newborn screening and comprehensive SCD care programmes. Such programmes would ensure that interventions such as prevention of infections using penicillin plus prompt diagnosis and treatment of complications are provided to all individuals with SCD. © 2014 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Active Smarter Kids (ASK): Rationale and design of a cluster-randomized controlled trial investigating the effects of daily physical activity on children's academic performance and risk factors for non-communicable diseases.

PubMed

Resaland, Geir K; Moe, Vegard Fusche; Aadland, Eivind; Steene-Johannessen, Jostein; Glosvik, Øyvind; Andersen, John R; Kvalheim, Olav M; McKay, Heather A; Anderssen, Sigmund A

2015-07-28

Evidence is emerging from school-based studies that physical activity might favorably affect children's academic performance. However, there is a need for high-quality studies to support this. Therefore, the main objective of the Active Smarter Kids (ASK) study is to investigate the effect of daily physical activity on children's academic performance. Because of the complexity of the relation between physical activity and academic performance it is important to identify mediating and moderating variables such as cognitive function, fitness, adiposity, motor skills and quality of life (QoL). Further, there are global concerns regarding the high prevalence of lifestyle-related non-communicable diseases (NCDs). The best means to address this challenge could be through primary prevention. Physical activity is known to play a key role in preventing a host of NCDs. Therefore, we investigated as a secondary objective the effect of the intervention on risk factors related to NCDs. The purpose of this paper is to describe the design of the ASK study, the ASK intervention as well as the scope and details of the methods we adopted to evaluate the effect of the ASK intervention on 5 (th) grade children. The ASK study is a cluster randomized controlled trial that includes 1145 fifth graders (aged 10 years) from 57 schools (28 intervention schools; 29 control schools) in Sogn and Fjordane County, Norway. This represents 95.3 % of total possible recruitment. Children in all 57 participating schools took part in a curriculum-prescribed physical activity intervention (90 min/week of physical education (PE) and 45 min/week physical activity, in total; 135 min/week). In addition, children from intervention schools also participated in the ASK intervention model (165 min/week), i.e. a total of 300 min/week of physical activity/PE. The ASK study was implemented over 7 months, from November 2014 to June 2015. We assessed academic performance in reading, numeracy and English using

The misuse of Cyproheptadine: a non-communicable disease risk behaviour in Kinshasa population, Democratic Republic of Congo.

PubMed

Lulebo, Aimée M; Bavuidibo, Carine D; Mafuta, Eric M; Ndelo, Josaphat D; Mputu, Lievin's Corneille M; Kabundji, Dalton M; Mutombo, Paulin B

2016-02-09

Obesity is one of the main risk factors of non-communicable diseases (NCDs) worldwide, especially in sub-Saharan Africa. The use of Cyproheptadine increases body weight and the risk of becoming obese. The aim of this study is to determine the prevalence of Cyproheptadine misuse in the Kinshasa population and to describe its characteristics. A cross-sectional study was conducted in two town sectors of Kinshasa, Democratic Republic of Congo (DRC), over a 4 month period (May 2011 to August 2011). Data from 499 participants, aged between 13 and 55 years were collected and analyzed. Mean and standard deviation were used for quantitative variables and frequency and percentage for categorical variables. In order to determine the relationship between socio-demographic status and Cyproheptadine use the Chi-square test was conducted. Student's t-test was used to compare means age of Cyproheptadine users and non-users. Logistic regression was used to determine predictors of Cyproheptadine use. A p-value of <0.05 was considered statistically significant. Overall, 499 participants were enrolled (352 females, 147 males, mean age ± standard deviation 24.9 ± 9.7 years) in the study. The majority of the study participants (72.9 %) had used Cyproheptadine as an appetite stimulant. Females were 11 times more likely to use Cryproheptadine (OR = 11.9; 95 % CI: 7.1-20.1) than males. People aged between 36 and 55 were three times less likely to use Cryproheptadine (OR = 0.3; 95 % CI: 0.2-0.8) compared to teenagers. More than half of the participants (69.0 %) declared to take daily Cyproheptadine. Half of the study participants (50.0 %) used Cyproheptadine for more than a year and also declared to combine it with Dexamethasone (87.6 %). This study shows that the Kinshasa population is significantly misusing Cyproheptadine and is highly exposed to its risk, including obesity.

National Institutes of Health funding for behavioral interventions to prevent chronic diseases.

PubMed

Calitz, Chris; Pollack, Keshia M; Millard, Chris; Yach, Derek

2015-04-01

Chronic non-communicable diseases (NCDs) cause the majority of premature deaths, disability, and healthcare expenditures in the U.S. Six largely modifiable risk behaviors and factors (tobacco use, poor nutrition, physical inactivity, alcohol abuse, drug abuse, and poor mental health) account for more than 50% of premature mortality and considerably more morbidity and disability. The IOM proposed that population burden of disease and preventability should be major determinants of the amount of research funding provided by the U.S. NIH. Data on NIH prevention funding between fiscal years 2010 and 2012 for human behavioral interventions that target the modifiable risk factors of NCDs were analyzed during 2013-2014. The NIH prevention portfolio comprises approximately 37% human behavioral studies and 63% basic biomedical, genetic, and animal studies. Approximately 65% of studies were secondary prevention versus 23% for primary prevention, and 71% of studies intervened at the individual and family levels. Diet and exercise were the most-studied risk factors (41%), and few studies conducted economic analyses (12%). NIH spends an estimated $2.2-$2.6 billion annually (7%-9% of the total of $30 billion) on human behavioral interventions to prevent NCDs. Although NIH prevention funding broadly aligns with the current burden of disease, overall funding remains low compared to funding for treatment, which suggests funding misalignment with the preventability of chronic diseases. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Common risk factors for chronic non-communicable diseases among older adults in China, Ghana, Mexico, India, Russia and South Africa: the study on global AGEing and adult health (SAGE) wave 1.

PubMed

Wu, Fan; Guo, Yanfei; Chatterji, Somnath; Zheng, Yang; Naidoo, Nirmala; Jiang, Yong; Biritwum, Richard; Yawson, Alfred; Minicuci, Nadia; Salinas-Rodriguez, Aaron; Manrique-Espinoza, Betty; Maximova, Tamara; Peltzer, Karl; Phaswanamafuya, Nancy; Snodgrass, James J; Thiele, Elizabeth; Ng, Nawi; Kowal, Paul

2015-02-06

countries. The baseline information on the magnitude of the problem of risk factors provided by this study can help countries and health policymakers to set up interventions addressing the global non-communicable disease epidemic.

Developmental origins of health and disease--global public health implications.

PubMed

Hanson, M A; Gluckman, P D

2015-01-01

The rapidly rising prevalence of non-communicable diseases (NCDs) represents a major challenge to public health and clinical medicine globally. NCDs are increasing rapidly in high-income countries, but even more rapidly in some low-middle-income countries with insufficient resources to meet the challenge. Whilst not identified in the Millennium Development Goals, there is much attention paid to NCDs in the discussions at many levels on the Sustainable Development Goals, as they underpin economic, social and environmental development in the post-2015 era. In this article, we discuss how a life-course approach to health, commencing of necessity in early development, can provide new opportunities for addressing this challenge. The approach can leverage human health capital throughout life and across generations. New insights into mechanisms, especially those processes by which the developmental environment affects epigenetic processes in the developing offspring, offer the prospect of identifying biomarkers of future risks. New interventions to promote health literacy, lifestyle and physical fitness in adolescents, young adults and their children hold great promise. In this respect, health-care professionals concerned with preconceptional, pregnancy and newborn care will have a vital role to play. Copyright © 2014 Elsevier Ltd. All rights reserved.

"They just come, pick and go." The Acceptability of Integrated Medication Adherence Clubs for HIV and Non Communicable Disease (NCD) Patients in Kibera, Kenya.

PubMed

Venables, Emilie; Edwards, Jeffrey K; Baert, Saar; Etienne, William; Khabala, Kelly; Bygrave, Helen

2016-01-01

The number of people on antiretroviral therapy (ART) for the long-term management of HIV in low- and middle-income countries (LMICs) is continuing to increase, along with the prevalence of Non-Communicable Diseases (NCDs). The need to provide large volumes of HIV patients with ART has led to significant adaptations in how medication is delivered, but access to NCD care remains limited in many contexts. Medication Adherence Clubs (MACs) were established in Kibera, Kenya to address the large numbers of patients requiring chronic HIV and/or NCD care. Stable NCD and HIV patients can now collect their chronic medication every three months through a club, rather than through individual clinic appointments. We conducted a qualitative research study to assess patient and health-care worker perceptions and experiences of MACs in the urban informal settlement of Kibera, Kenya. A total of 106 patients (with HIV and/or other NCDs) and health-care workers were purposively sampled and included in the study. Ten focus groups and 19 in-depth interviews were conducted and 15 sessions of participant observation were carried out at the clinic where the MACs took place. Thematic data analysis was conducted using NVivo software, and coding focussed on people's experiences of MACs, the challenges they faced and their perceptions about models of care for chronic conditions. MACs were considered acceptable to patients and health-care workers because they saved time, prevented unnecessary queues in the clinic and provided people with health education and group support whilst they collected their medication. Some patients and health-care workers felt that MACs reduced stigma for HIV positive patients by treating HIV as any other chronic condition. Staff and patients reported challenges recruiting patients into MACs, including patients not fully understanding the eligibility criteria for the clubs. There were also some practical challenges during the implementation of the clubs, but MACs

Diagnosis, monitoring and prevention of exposure-related non-communicable diseases in the living and working environment: DiMoPEx-project is designed to determine the impacts of environmental exposure on human health.

PubMed

Budnik, Lygia Therese; Adam, Balazs; Albin, Maria; Banelli, Barbara; Baur, Xaver; Belpoggi, Fiorella; Bolognesi, Claudia; Broberg, Karin; Gustavsson, Per; Göen, Thomas; Fischer, Axel; Jarosinska, Dorota; Manservisi, Fabiana; O'Kennedy, Richard; Øvrevik, Johan; Paunovic, Elizabet; Ritz, Beate; Scheepers, Paul T J; Schlünssen, Vivi; Schwarzenbach, Heidi; Schwarze, Per E; Sheils, Orla; Sigsgaard, Torben; Van Damme, Karel; Casteleyn, Ludwine

2018-01-01

The WHO has ranked environmental hazardous exposures in the living and working environment among the top risk factors for chronic disease mortality. Worldwide, about 40 million people die each year from noncommunicable diseases (NCDs) including cancer, diabetes, and chronic cardiovascular, neurological and lung diseases. The exposure to ambient pollution in the living and working environment is exacerbated by individual susceptibilities and lifestyle-driven factors to produce complex and complicated NCD etiologies. Research addressing the links between environmental exposure and disease prevalence is key for prevention of the pandemic increase in NCD morbidity and mortality. However, the long latency, the chronic course of some diseases and the necessity to address cumulative exposures over very long periods does mean that it is often difficult to identify causal environmental exposures. EU-funded COST Action DiMoPEx is developing new concepts for a better understanding of health-environment (including gene-environment) interactions in the etiology of NCDs. The overarching idea is to teach and train scientists and physicians to learn how to include efficient and valid exposure assessments in their research and in their clinical practice in current and future cooperative projects. DiMoPEx partners have identified some of the emerging research needs, which include the lack of evidence-based exposure data and the need for human-equivalent animal models mirroring human lifespan and low-dose cumulative exposures. Utilizing an interdisciplinary approach incorporating seven working groups, DiMoPEx will focus on aspects of air pollution with particulate matter including dust and fibers and on exposure to low doses of solvents and sensitizing agents. Biomarkers of early exposure and their associated effects as indicators of disease-derived information will be tested and standardized within individual projects. Risks arising from some NCDs, like pneumoconioses, cancers and

Socioeconomic inequalities in premature mortality in Colombia, 1998-2007: the double burden of non-communicable diseases and injuries.

PubMed

Arroyave, Ivan; Burdorf, Alex; Cardona, Doris; Avendano, Mauricio

2014-07-01

Non-communicable diseases have become the leading cause of death in middle-income countries, but mortality from injuries and infections remains high. We examined the contribution of specific causes to disparities in adult premature mortality (ages 25-64) by educational level from 1998 to 2007 in Colombia. Data from mortality registries were linked to population censuses to obtain mortality rates by educational attainment. We used Poisson regression to model trends in mortality by educational attainment and estimated the contribution of specific causes to the Slope Index of Inequality. Men and women with only primary education had higher premature mortality than men and women with post-secondary education (RRmen=2.60, 95% confidence interval [CI]: 2.56, 2.64; RRwomen=2.36, CI: 2.31, 2.42). Mortality declined in all educational groups, but declines were significantly larger for higher-educated men and women. Homicide explained 55.1% of male inequalities while non-communicable diseases explained 62.5% of female inequalities and 27.1% of male inequalities. Infections explained a small proportion of inequalities in mortality. Injuries and non-communicable diseases contribute considerably to disparities in premature mortality in Colombia. Multi-sector policies to reduce both interpersonal violence and non-communicable disease risk factors are required to curb mortality disparities. Copyright © 2014 Elsevier Inc. All rights reserved.

Socioeconomic inequalities in premature mortality in Colombia, 1998-2007: The double burden of non-communicable diseases and injuries

PubMed Central

Arroyave, Ivan; Burdorf, Alex; Cardona, Doris; Avendano, Mauricio

2014-01-01

Objectives Non-communicable diseases have become the leading cause of death in middle-income countries, but mortality from injuries and infections remains high. We examined the contribution of specific causes to disparities in adult premature mortality (ages 25-64) by educational level from 1998 to 2007 in Colombia. Methods Data from mortality registries were linked to population censuses to obtain mortality rates by educational attainment. We used Poisson regression to model trends in mortality by educational attainment and estimated the contribution of specific causes to the Slope Index of Inequality. Results Men and women with only primary education had higher premature mortality than men and women with post-secondary education (RRmen=2·60, 95% confidence interval [CI]:2·56, 2·64; RRwomen=2·36, CI:2·31, 2·42). Mortality declined in all educational groups, but declines were significantly larger for higher-educated men and women. Homicide explained 55·1% of male inequalities while non-communicable diseases explained 62·5% of female inequalities and 27·1% of male inequalities. Infections explained a small proportion of inequalities in mortality. Conclusion Injuries and non-communicable diseases contribute considerably to disparities in premature mortality in Colombia. Multi-sector policies to reduce both interpersonal violence and non-communicable disease risk factors are required to curb mortality disparities. PMID:24674854

Redesigning primary care to tackle the global epidemic of noncommunicable disease.

PubMed

Kruk, Margaret E; Nigenda, Gustavo; Knaul, Felicia M

2015-03-01

Noncommunicable diseases (NCDs) have become the major contributors to death and disability worldwide. Nearly 80% of the deaths in 2010 occurred in low- and middle-income countries, which have experienced rapid population aging, urbanization, rise in smoking, and changes in diet and activity. Yet the health systems of low- and middle-income countries, historically oriented to infectious disease and often severely underfunded, are poorly prepared for the challenge of caring for people with cardiovascular disease, diabetes, cancer, and chronic respiratory disease. We have discussed how primary care can be redesigned to tackle the challenge of NCDs in resource-constrained countries. We suggest that four changes will be required: integration of services, innovative service delivery, a focus on patients and communities, and adoption of new technologies for communication.

Describing the primary care system capacity for the prevention and management of non-communicable diseases in rural Vietnam.

PubMed

Van Minh, Hoang; Do, Young Kyung; Bautista, Mary Ann Cruz; Tuan Anh, Tran

2014-01-01

The primary care system in Vietnam has been shown to play a crucial role in disease prevention and health promotion. This study described the primary care system in a selected rural area in Vietnam in terms of its capacity for prevention and control of non-communicable diseases (NCDs). The study was conducted in 2011 in Dong Hy district, Thai Nguyen province-a rural community located in northern Vietnam. Mixed methods were used, including quantitative and qualitative and literature review approaches, to collect data on the current status of the six building blocks of the primary care system in Dong Hy district. Selected health workers and stakeholders in the selected healthcare facilities were surveyed. A description of Dong Hy district's primary care capacity for NCD prevention and control is reported. (i) Service delivery: The current practice in NCD prevention and treatment is mainly based on a single risk factor rather than a combination of cardiovascular disease risks. (ii) Governance: At the primary care level, multi-sectoral collaborations are limited, and there is insufficient integration of NCD preventive activities. (iii) Financing: A national budget for NCD prevention and control is lacking. The cost of treatment and medicines is high, whereas the health insurance scheme limits the list of available medicines and the reimbursement ceiling level. Health workers have low remuneration despite their important roles in NCD prevention. (iv) Human resources: The quantity and quality of health staff working at the primary care level, especially those in preventive medicine, are insufficient. (v) Information and research: The health information system in the district is weak, and there is no specific information system for collecting population-based NCD data. (vi) Medical products and technology: Not all essential equipment and medicines recommended by the WHO are always available at the commune health centre. The capacity of the primary care system in Vietnam

The future burden of obesity-related diseases in the 53 WHO European-Region countries and the impact of effective interventions: a modelling study

PubMed Central

Webber, Laura; Divajeva, Diana; Marsh, Tim; McPherson, Klim; Brown, Martin; Galea, Gauden; Breda, Joao

2014-01-01

Objective Non-communicable diseases (NCDs) are the biggest cause of death in Europe putting an unsustainable burden on already struggling health systems. Increases in obesity are a major cause of NCDs. This paper projects the future burden of coronary heart disease (CHD), stroke, type 2 diabetes and seven cancers by 2030 in 53 WHO European Region countries based on current and past body mass index (BMI) trends. It also tests the impact of obesity interventions on the future disease burden. Setting and participants Secondary data analysis of country-specific epidemiological data using a microsimulation modelling process. Interventions The effect of three hypothetical scenarios on the future burden of disease in 2030 was tested: baseline scenario, BMI trends go unchecked; intervention 1, population BMI decreases by 1%; intervention 2, BMI decreases by 5%. Primary and secondary outcome measures Quantifying the future burden of major NCDs and the impact of interventions on this future disease burden. Results By 2030 in the whole of the European region, the prevalence of diabetes, CHD and stroke and cancers was projected to reach an average of 3990, 4672 and 2046 cases/100 000, respectively. The highest prevalence of diabetes was predicted in Slovakia (10 870), CHD and stroke—in Greece (11 292) and cancers—in Finland (5615 cases/100 000). A 5% fall in population BMI was projected to significantly reduce cumulative incidence of diseases. The largest reduction in diabetes and CHD and stroke was observed in Slovakia (3054 and 3369 cases/100 000, respectively), and in cancers was predicted in Germany (331/100 000). Conclusions Modelling future disease trends is a useful tool for policymakers so that they can allocate resources effectively and implement policies to prevent NCDs. Future research will allow real policy interventions to be tested; however, better surveillance data on NCDs and their risk factors are essential for research and policy. PMID

Developing an Action Model for Integration of Health System Response to HIV/AIDS and Noncommunicable Diseases (NCDs) in Developing Countries

PubMed Central

Haregu, Tilahun Nigatu; Setswe, Geoffrey; Elliott, Julian; Oldenburg, Brian

2014-01-01

Introduction: Although there are several models of integrated architecture, we still lack models and theories about the integration process of health system responses to HIV/AIDS and NCDs. Objective: The overall purpose of this study is to design an action model, a systematic approach, for the integration of health system responses to HIV/AIDS and NCDs in developing countries. Methods: An iterative and progressive approach of model development using inductive qualitative evidence synthesis techniques was applied. As evidence about integration is spread across different fields, synthesis of evidence from a broad range of disciplines was conducted. Results: An action model of integration having 5 underlying principles, 4 action fields, and a 9-step action cycle is developed. The INTEGRATE model is an acronym of the 9 steps of the integration process: 1) Interrelate the magnitude and distribution of the problems, 2) Navigate the linkage between the problems, 3) Testify individual level co-occurrence of the problems, 4) Examine the similarities and understand the differences between the response functions, 5) Glance over the health system’s environment for integration, 6) Repackage and share evidence in a useable form, 7) Ascertain the plan for integration, 8) Translate the plan in to action, 9) Evaluate and Monitor the integration. Conclusion: Our model provides a basis for integration of health system responses to HIV/AIDS and NCDs in the context of developing countries. We propose that future empirical work is needed to refine the validity and applicability of the model. PMID:24373260

[Transitions in context: findings related to rural-to-urban migration and chronic non-communicable diseases in Peru].

PubMed

Miranda, J Jaime; Wells, Jonathan C K; Smeeth, Liam

2012-01-01

In order to better understand the emergence of chronic non-communicable diseases in low- and middle-income countries this article seeks to present, in context, different transitional processes which societies and populations are currently undergoing. Relevant factors for specific contexts such as Peru are described, including internal migration, urbanization and profiles of adversity in early life, all of them linked to chronic non-communicable diseases, including obesity and overweight. The capacity-load model, which considers chronic disease risk in adulthood as a function of two generic traits, metabolic capacity and metabolic load, is described. The contribution of rural-to-urban migration to this problem is also presented. Finally, these topics are framed within pending challenges for public health in Peru.

Socioeconomic Inequality of Non-Communicable Risk Factors among People Living in Kurdistan Province, Islamic Republic of Iran.

PubMed

Moradi, Ghobad; Mohammad, Kazem; Majdzadeh, Reza; Ardakani, Hossein Malekafzali; Naieni, Kourosh Holakouie

2013-06-01

The most fundamental way to decrease the burden of noncommunicable diseases (NCDs) is to identify and control their related risk factors. The goal of this study is to determine socioeconomic inequalities in risk factors for NCDs using concentration index based on Non-Communicable Disease Surveillance Survey (NCDSS) data in Kurdistan province, Islamic Republic of Iran in 2005 and 2009. The required data for this study are taken from two NCDSSs in Kurdistan province in 2005 and 2009. A total of 2,494 persons in 2005 and 997 persons in 2009 were assessed. Concentration index was used to determine socioeconomic inequality. To assess the relationship between the prevalence of each risk factor and socioeconomic status (SES), logistic regression was used and odds ratio (OR) was calculated for each group, compared with the poorest group. The concentration index for hypertension was -0.095 (-0.158, -0.032) in 2005 and -0.080 (-0.156, -0.003) in 2009. The concentration index for insufficient consumption of fruits and vegetables was -0.117 (-0.153, -0.082) in 2005 and -0.100 (-0.153, -0.082) in 2009. The concentration index for the consumption of unhealthy fat and oil was -0.034 (-0.049, -0.019) in 2005 and -0.108 (-0.165, -0.051) in 2009. The concentration index for insufficient consumption of fish was -0.070 (-0.096, -0.044) in 2005. The concentration index for physical inactivity was 0.008 (-0.057, 0.075) in 2005 and 0.139 (0.063, 0.215) in 2009. In all the cases, the OR of the richest group to the poorest group was significant. Hypertension, insufficient consumption of fruits and vegetables, consumption of unhealthy fat and oil, and insufficient consumption of fish are more prevalent among poor groups. There was no significant socioeconomic inequality in the distribution of smoking, excess weight, and hypercholesterolemia. Physical inactivity was more prevalent among the rich groups of society in 2009. The reduction of socioeconomic inequalities must become a main goal in

What are the Evidence Based Public Health Interventions for Prevention and Control of NCDs in Relation to India?

PubMed

Singh, Kavita; Reddy, K Srinath; Prabhakaran, Dorairaj

2011-12-01

The accelerating epidemics of noncommunicable diseases (NCDs) in India call for a comprehensive public health response which can effectively combat and control them before they peak and inflict severe damage in terms of unaffordable health, economic, and social costs. To synthesize and present recent evidences regarding the effectiveness of several types of public health interventions to reduce NCD burden. Interventions influencing behavioral risk factors (like unhealthy diet, physical inactivity, tobacco and alcohol consumption) through policy, public education, or a combination of both have been demonstrated to be effective in reducing the NCD risk in populations as well as in individuals. Policy interventions are also effective in reducing the levels of several major biological risk factors linked to NCDs (high blood pressure; overweight and obesity; diabetes and abnormal blood cholesterol). Secondary prevention along the lines of combination pills and ensuring evidenced based clinical care are also critical. Though the evidence for health promotion and primary prevention are weaker, policy interventions and secondary prevention when combined with these are likely to have a greater impact on reducing national NCD burden. A comprehensive and integrated response to NCDs control and prevention needs a "life course approach." Proven cost-effective interventions need to be integrated in a NCD prevention and control policy framework and implemented through coordinated mechanisms of regulation, environment modification, education, and health care responses.

What are the Evidence Based Public Health Interventions for Prevention and Control of NCDs in Relation to India?

PubMed Central

Singh, Kavita; Reddy, K Srinath; Prabhakaran, Dorairaj

2011-01-01

The accelerating epidemics of noncommunicable diseases (NCDs) in India call for a comprehensive public health response which can effectively combat and control them before they peak and inflict severe damage in terms of unaffordable health, economic, and social costs. To synthesize and present recent evidences regarding the effectiveness of several types of public health interventions to reduce NCD burden. Interventions influencing behavioral risk factors (like unhealthy diet, physical inactivity, tobacco and alcohol consumption) through policy, public education, or a combination of both have been demonstrated to be effective in reducing the NCD risk in populations as well as in individuals. Policy interventions are also effective in reducing the levels of several major biological risk factors linked to NCDs (high blood pressure; overweight and obesity; diabetes and abnormal blood cholesterol). Secondary prevention along the lines of combination pills and ensuring evidenced based clinical care are also critical. Though the evidence for health promotion and primary prevention are weaker, policy interventions and secondary prevention when combined with these are likely to have a greater impact on reducing national NCD burden. A comprehensive and integrated response to NCDs control and prevention needs a “life course approach.” Proven cost-effective interventions need to be integrated in a NCD prevention and control policy framework and implemented through coordinated mechanisms of regulation, environment modification, education, and health care responses. PMID:22628907

Social and Economic Implications of Noncommunicable diseases in India

PubMed Central

Thakur, JS; Prinja, Shankar; Garg, Charu C; Mendis, Shanthi; Menabde, Nata

2011-01-01

Noncommunicable diseases (NCDs) have become a major public health problem in India accounting for 62% of the total burden of foregone DALYs and 53% of total deaths. In this paper, we review the social and economic impact of NCDs in India. We outline this impact at household, health system and the macroeconomic level. Cardiovascular diseases (CVDs) figure at the top among the leading ten causes of adult (25–69 years) deaths in India. The effects of NCDs are inequitable with evidence of reversal in social gradient of risk factors and greater financial implications for the poorer households in India. Out-of-pocket expenditure associated with the acute and long-term effects of NCDs is high resulting in catastrophic health expenditure for the households. Study in India showed that about 25% of families with a member with CVD and 50% with cancer experience catastrophic expenditure and 10% and 25%, respectively, are driven to poverty. The odds of incurring catastrophic hospitalization expenditure were nearly 160% higher with cancer than the odds of incurring catastrophic spending when hospitalization was due to a communicable disease. These high numbers also pose significant challenge for the health system for providing treatment, care and support. The proportion of hospitalizations and outpatient consultations as a result of NCDs rose from 32% to 40% and 22% to 35%, respectively, within a decade from 1995 to 2004. In macroeconomic term, most of the estimates suggest that the NCDs in India account for an economic burden in the range of 5–10% of GDP, which is significant and slowing down GDP thus hampering development. While India is simultaneously experiencing several disease burdens due to old and new infections, nutritional deficiencies, chronic diseases, and injuries, individual interventions for clinical care are unlikely to be affordable on a large scale. While it is clear that “treating our way out” of the NCDs may not be the efficient way, it has to be

Factors influencing integrated wellbeing in older Chinese outpatients with chronic diseases.

PubMed

Huang, Fei; Li, Hongyu

2018-03-16

To evaluate wellbeing and its determinants among older Chinese outpatients with non-communicable diseases (NCDs), outpatients (aged ≥60 years) with NCDs between September 2012 and September 2014 were enrolled in the study by convenience sampling. Each subject completed an integrated wellbeing questionnaire for subjective, psychological and social dimensions of wellbeing. Statistical analyses were performed using t-test, ANOVA, Spearman rank correlation and multivariate regression analysis to identify correlates of wellbeing status. The average integrated wellbeing score was 52.57 out of 98, with maximum of 72. Educational background and monthly income were positively associated with wellbeing (Spearman r=0.226 and 0.394 respectively; all P<0.001). The number of co-morbid conditions and the disease duration showed a negative correlation with wellbeing (Spearman r=-0.373 and -0.538 respectively; all P<0.001). Lack of access to health insurance, being single and presence of complications were associated with lower wellbeing (all P≤0.001). As the first study using an integrated wellbeing model, the results suggested wellbeing promotion among older outpatients with chronic diseases, especially those with lower income, lower education level, those who lack health insurance, single individuals, those with co-morbid conditions, longer disease duration and those with complications.

The economic cost of physical inactivity in China.

PubMed

Zhang, Juan; Chaaban, Jad

2013-01-01

To estimate the total economic burden of physical inactivity in China. The costs of physical inactivity combine the medical and non-medical costs of five major Non Communicable Diseases (NCDs) associated with inactivity. The national data from the Chinese Behavioral Risk Factors Surveillance Surveys (2007) and the National Health Service Survey (2003) are used to compute population attributable risks (PARs) of inactivity for each major NCD. Costs specific to inactivity are obtained by multiplying each disease costs by the PAR for each NCD, by incorporating the inactivity effects through overweight and obesity. Physical inactivity contributes between 12% and 19% to the risks associated with the five major NCDs in China, namely coronary heart disease, stroke, hypertension, cancer, and type 2 diabetes. Physical inactivity is imposing a substantial economic burden on the country, as it is responsible alone for more than 15% of the medical and non-medical yearly costs of the main NCDs in the country. The high economic burden of physical inactivity implies the need to develop more programs and interventions that address this modifiable behavioral risk, in order to curb the rising NCDs epidemic in China. Copyright © 2012 Elsevier Inc. All rights reserved.

Redesigning Primary Care to Tackle the Global Epidemic of Noncommunicable Disease

PubMed Central

Nigenda, Gustavo; Knaul, Felicia M.

2015-01-01

Noncommunicable diseases (NCDs) have become the major contributors to death and disability worldwide. Nearly 80% of the deaths in 2010 occurred in low- and middle-income countries, which have experienced rapid population aging, urbanization, rise in smoking, and changes in diet and activity. Yet the health systems of low- and middle-income countries, historically oriented to infectious disease and often severely underfunded, are poorly prepared for the challenge of caring for people with cardiovascular disease, diabetes, cancer, and chronic respiratory disease. We have discussed how primary care can be redesigned to tackle the challenge of NCDs in resource-constrained countries. We suggest that four changes will be required: integration of services, innovative service delivery, a focus on patients and communities, and adoption of new technologies for communication. PMID:25602898

[Integration of mental health and chronic non-communicable diseases in Peru: challenges and opportunities for primary care settings].

PubMed

Diez-Canseco, Francisco; Ipince, Alessandra; Toyama, Mauricio; Benate-Galvez, Ysabel; Galán-Rodas, Edén; Medina-Verástegui, Julio César; Sánchez-Moreno, David; Araya, Ricardo; Miranda, J Jaime

2014-01-01

In this article, the relationship between mental health and chronic non-communicable diseases is discussed as well as the possibility to address them in a comprehensive manner in the Peruvian health system. First, the prevalence estimates and the burden of chronic non-communicable diseases and mental disorders worldwide and in Peru are reviewed. Then, the detrimental impact of depression in the early stages as well as the progress of diabetes and cardiovascular diseases is described. Additionally, the gap between access to mental health care in Peru is analyzed. Lastly, the alternatives to reduce the gap are explored. Of these alternatives, the integration of mental health into primary care services is emphasized; as a feasible way to meet the care needs of the general population, and people with chronic diseases in particular, in the Peruvian context.

Implications of the World Trade Organization in combating non-communicable diseases.

PubMed

Mitchell, A; Voon, T

2011-12-01

The World Health Organization (WHO) has proposed a number of strategies to combat non-communicable diseases such as cancers, cardiovascular diseases, chronic respiratory diseases and diabetes by targeting the risk factors of tobacco use, harmful use of alcohol and poor diet. A number of the domestic regulatory responses contemplated by WHO and individual countries have the potential to restrict or distort trade, raising the question of whether they are consistent with the obligations imposed on Members of the World Trade Organization (WTO). This article demonstrates that WTO rules do limit Members' flexibility in implementing public health measures to address these diseases. However, the focus of WTO provisions on preventing discrimination against or between imports and the exceptions incorporated in various WTO agreements leave sufficient scope for Members to design carefully directed measures to achieve genuine public health goals while minimizing negative effects on international trade. Copyright © 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

National disease management plans for key chronic non-communicable diseases in Singapore.

PubMed

Tan, C C

2002-07-01

In Singapore, chronic, non-communicable diseases, namely coronary heart disease, stroke and cancer, account for more than 60% of all deaths and a high burden of disability and healthcare expenditure. The burden of these diseases is likely to rise with our rapidly ageing population and changing lifestyles, and will present profound challenges to our healthcare delivery and financing systems over the next 20 to 30 years. The containment and optimal management of these conditions require a strong emphasis on patient education and the development of integrated models of healthcare delivery in place of the present uncoordinated, compartmentalised way of delivering healthcare. To meet these challenges, the Ministry of Health's major thrusts are disease control measures which focus mainly on primary prevention; and disease management, which coordinates the national effort to reduce the incidence of these key diseases and their predisposing factors and to ameliorate their long-term impact by optimising control to reduce mortality, morbidity and complications, and improving functional status through rehabilitation. The key initiatives include restructuring of the public sector healthcare institutions into two clusters, each comprising a network of primary health care polyclinics, regional hospitals and tertiary institutions. The functional integration of these healthcare elements within each cluster under a common senior administrative and professional management, and the development of common clinical IT systems will greatly facilitate the implementation of disease management programmes. Secondly, the Ministry is establishing National Disease Registries in coronary heart disease, cancer, stroke, myopia and kidney failure, which will be valuable sources of clinical and outcomes data. Thirdly, in partnership with expert groups, national committees and professional agencies, the Ministry will produce clinical practice guidelines which will assist doctors and healthcare

Impact of Nutrition Transition and Resulting Morbidities on Economic and Human Development.

PubMed

Gayathri, Rajagopal; Ruchi, Vaidya; Mohan, Viswanathan

2017-01-01

Nutrition transition is an adverse outcome of rapid economic development and globalization. The present review documents the pattern of nutrition and health transition among different food groups leading to the growing global and national epidemic of non-communicable diseases (NCDs). Studies published in various national and international journals were searched using PubMed and Google Scholar search engines from the year 2000 to 2015. Literature was reviewed to gather data pertaining to nutrition and health transition and economic burden of non-communicable disease (NCDs). Diets are changing globally towards higher intakes of simple and refined carbohydrates (including sugar), fat and lower intake of complex carbohydrates. The upsurge of co-morbidities arising from nutrition transition is a serious threat worldwide especially in developing countries like India, which in turn poses a huge impact on economic development of the nation. Better awareness and encouragement of using healthier diet option can help to combat the epidemic of NCDs in the developing world. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Malnutrition and non-communicable diseases among Bangladeshi women: an urban–rural comparison

PubMed Central

Zahangir, M S; Hasan, M M; Richardson, A; Tabassum, S

2017-01-01

Background/Objectives: This study aims at examining the urban–rural differentials in the effects of socioeconomic predictors on underweight and obesity of ever-married women in Bangladesh. The effect of malnutrition and other risk factors on non-communicable diseases is also examined. Subjects/Methods: The information regarding nutritional status, socioeconomic and demographic background, and non-communicable diseases of ever-married women was extracted from the nationally representative, cross-sectional Bangladesh Demographic and Health Survey (BDHS 2011) data set. Both bivariate (χ2 test) and multivariate (multinomial logistic regression model) analyses were performed in determining the risk factors of malnutrition. The effect of malnutrition and associated risk factors on non-communicable diseases was determined using binary logistic regression models. Results: The overall prevalence as well as the effects of individual risk factors of malnutrition differ in urban and rural settings. Regional differentials in the prevalence of underweight were statistically significant only for rural areas. In rural and urban settings, women from households with poor economic status were 67% (odds ratio (OR) 0.33, 95% CI 0.26–0.43) and 81% (OR=0.19, 95% CI 0.13–0.29) less likely to be overweight, respectively, with respect to those from affluent households. Women from the Rangpur division were significantly more likely to suffer from anemia (OR=1.41, 95% CI 1.13–1.77) and hypertension (OR=1.67, 95% CI 1.19–2.34) than those from the Sylhet division (reference division). With respect to those considered as underweight, women who were categorized as overweight were 0.47 (OR=0.53, 95% CI 0.43–0.65) times less likely to suffer from anemia, and 1.83 (OR=2.83, 95% CI 1.99–4.02) and 1.70 (OR=2.70, 95% CI 2.09–3.50) times more likely to suffer from diabetes and hypertension, respectively. Conclusions: Rural–urban differentials in the effects of individual risk factors

Tackling the chronic disease burden: are there co-benefits from climate policy measures?

PubMed

Vandenberghe, Désirée; Albrecht, Johan

2018-04-26

Each year, non-communicable diseases (NCDs) kill 40 million people worldwide and impose an estimated economic burden of $600 billion. Without effective policymaking, NCDs will continue to undermine health and economic systems globally. We propose that climate policy measures-such as carbon pricing-can yield significant health-related co-benefits aside from their intended greenhouse gas emission reduction. We simulate three carbon tax scenarios in the energy and food sector in Belgium and assess the resulting health-related co-benefits. These benefits originate from decreased exposure to two leading NCD risk factors: fine particulate matter and dietary regimes excessive in animal products. The carbon tax could prevent 42,300-78,800 Disability-Adjusted Life Years in Belgium, or save 0.6-1.1% of total health care expenditure and an additional 0.06-0.12% of Belgian GDP. We conclude that these health-related co-benefits should be included in the cost-benefit analysis of carbon pricing.

Exploring chronic disease in Bolivia: A cross-sectional study in La Paz.

PubMed

Abbott, Patricia; Banerjee, Tanima; Aruquipa Yujra, Amparo Clara; Xie, Boqin; Piette, John

2018-01-01

This study seeks to develop an understanding that can guide development of programs to improve health and care for individuals with Non-Communicable Diseases (NCDs) in La Paz, Bolivia, where NCDs are prevalent and primary care systems are weak. This exploratory investigation examines the characteristics of chronic disease patients in the region, key health related behaviors, and their perceptions of the care that they receive. The longer-term goal is to lay groundwork for interventional studies based on the principles of the Chronic Care Model (CCM). The study is based on two surveys of adults (> 18 years old) administered in 2014 in La Paz, Bolivia. A total of 1165 adult patients participated in the first screening survey. A post-screening second survey, administered only on those who qualified based on Survey 1, collected more detailed information about the subjects' general health and health related personal circumstances, several health behaviors, health literacy, and their perceptions of care received. A final data set of 651 merged records were used for analysis. Characteristic of a low-income country, the majority of participants had low levels of education, income, health literacy and high rates of under/unemployment. Nearly 50% of participants reported 2 or more NCDs. Seventy-four percent (74%) of respondents reported low levels of medication adherence and 26% of the population was found to have an undiagnosed depressive disorder. Overall, the perception of care quality was low (60%), particularly in those under the age of 45. Significant relationships emerged between several sociodemographic characteristics, health behaviors, and perceptions that have major implications for improving NCD care in this population. These findings illustrate some of the challenges facing low-income countries where reversing the tide of NCDs is of great importance. The prevalence of NCDs coupled with challenging social determinants of health, poor medication adherence, low

Exploring chronic disease in Bolivia: A cross-sectional study in La Paz

PubMed Central

Banerjee, Tanima; Aruquipa Yujra, Amparo Clara; Xie, Boqin; Piette, John

2018-01-01

Purpose This study seeks to develop an understanding that can guide development of programs to improve health and care for individuals with Non-Communicable Diseases (NCDs) in La Paz, Bolivia, where NCDs are prevalent and primary care systems are weak. This exploratory investigation examines the characteristics of chronic disease patients in the region, key health related behaviors, and their perceptions of the care that they receive. The longer-term goal is to lay groundwork for interventional studies based on the principles of the Chronic Care Model (CCM). Subjects and methods The study is based on two surveys of adults (> 18 years old) administered in 2014 in La Paz, Bolivia. A total of 1165 adult patients participated in the first screening survey. A post-screening second survey, administered only on those who qualified based on Survey 1, collected more detailed information about the subjects’ general health and health related personal circumstances, several health behaviors, health literacy, and their perceptions of care received. A final data set of 651 merged records were used for analysis. Results Characteristic of a low-income country, the majority of participants had low levels of education, income, health literacy and high rates of under/unemployment. Nearly 50% of participants reported 2 or more NCDs. Seventy-four percent (74%) of respondents reported low levels of medication adherence and 26% of the population was found to have an undiagnosed depressive disorder. Overall, the perception of care quality was low (60%), particularly in those under the age of 45. Significant relationships emerged between several sociodemographic characteristics, health behaviors, and perceptions that have major implications for improving NCD care in this population. Conclusions These findings illustrate some of the challenges facing low-income countries where reversing the tide of NCDs is of great importance. The prevalence of NCDs coupled with challenging social

Economic evaluations of non-communicable disease interventions in developing countries: a critical review of the evidence base

PubMed Central

Mulligan, Jo-Ann; Walker, Damian; Fox-Rushby, Julia

2006-01-01

Background Demographic projections suggest a major increase in non-communicable disease (NCD) mortality over the next two decades in developing countries. In a climate of scarce resources, policy-makers need to know which interventions represent value for money. The prohibitive cost of performing multiple economic evaluations has generated interest in transferring the results of studies from one setting to another. This paper aims to bridge the gap in the current literature by critically evaluating the available published data on economic evaluations of NCD interventions in developing countries. Methods We identified and reviewed the methodological quality of 32 economic evaluations of NCD interventions in developing countries. Developing countries were defined according to the World Bank classification for low- and lower middle-income countries. We defined NCDs as the 12 categories listed in the 1993 World Bank report Investing in Health. English language literature was searched for the period January 1984 and January 2003 inclusive in Medline, Science Citation Index, HealthStar, NHS Economic Evaluation Database and Embase using medical subheading terms and free text searches. We then assessed the quality of studies according to a set of pre-defined technical criteria. Results We found that the quality of studies was poor and resource allocation decisions made by local and global policy-makers on the basis of this evidence could be misleading. Furthermore we have identified some clear gaps in the literature, particularly around injuries and strategies for tackling the consequences of the emerging tobacco epidemic. Conclusion In the face of poor evidence the role of so-called generalised cost-effectiveness analyses has an important role to play in aiding public health decision-making at the global level. Further research is needed to investigates the causes of variation among cost, effects and cost-effectiveness data within and between settings. Such analyses still

Non-communicable disease (NCD) risk factors and diabetes among adults living in slum areas of Dhaka, Bangladesh.

PubMed

Rawal, Lal B; Biswas, Tuhin; Khandker, Nusrat Nausheen; Saha, Shekhar Ranjan; Bidat Chowdhury, Mohammed Mahiul; Khan, Abdullah Nurus Salam; Chowdhury, Enamul Hasib; Renzaho, Andre

2017-01-01

Despite one-third of the urban population in Bangladesh living in urban slums and at increased risk of non-communicable diseases (NCDs), little is known about the NCD risk profile of this at-risk population. The aim of the study was to identify the prevalence of the NCD risk factors and the association of NCD risk factors with socio-demographic factors among the adults of urban slums in Dhaka, Bangladesh. A cross-sectional study was conducted among adult slum dwellers (aged 25 and above) residing in three purposively selected urban slums of Dhaka for at least six months preceding the survey. The risk factors assessed were- currently smoking, fruit and vegetable intake, physical activity, hypertension and body mass index (BMI). Information on self-reported diabetes was also taken. A total of 507 participants (252 females; 49.7%) were interviewed and their physical measures were taken using the WHO NCD STEPS instrument. The overall prevalence of NCD risk factors was: 36.0% (95% CI: 31.82-40.41) for smoking; 95.60% (95% CI: 93.60-97.40) for insufficient fruit and vegetable intake; 15.30% (95% CI:12.12-18.71) for low physical activity;13.70% (95% CI: 10.71-16.92) for hypertension; 22.70% (95% CI: 19.31-26.02) for overweight or obesity; and 5.00% (95%: 3.20-7.00) for self-reported diabetes. In the logistic regression model, the clustering of three or more NCD risk factors was positively associated with younger age groups (p = 0.02), no formal education (p <0.001) and primary education level (p = 0.01), but did not differ by sex of the participants, monthly income and occupation. All NCD risk factors are markedly high among the urban slum adults. These findings are important to support the formulation and implementation of NCD-related polices and plan of actions that recognize urban slum populations in Bangladesh as a priority sub-population.

Prevention and management of non-communicable disease: the IOC consensus statement, Lausanne 2013.

PubMed

Matheson, Gordon O; Klügl, Martin; Engebretsen, Lars; Bendiksen, Fredrik; Blair, Steven N; Börjesson, Mats; Budgett, Richard; Derman, Wayne; Erdener, Uğur; Ioannidis, John P A; Khan, Karim M; Martinez, Rodrigo; van Mechelen, Willem; Mountjoy, Margo; Sallis, Robert E; Schwellnus, Martin; Shultz, Rebecca; Soligard, Torbjørn; Steffen, Kathrin; Sundberg, Carl Johan; Weiler, Richard; Ljungqvist, Arne

2013-11-01

Morbidity and mortality from preventable, non-communicable chronic disease (NCD) threatens the health of our populations and our economies. The accumulation of vast amounts of scientific knowledge has done little to change this. New and innovative thinking is essential to foster new creative approaches that leverage and integrate evidence through the support of big data, technology, and design thinking. The purpose of this paper is to summarize the results of a consensus meeting on NCD prevention sponsored by the International Olympic Committee (IOC) in April, 2013. Within the context of advocacy for multifaceted systems change, the IOC's focus is to create solutions that gain traction within health care systems. The group of participants attending the meeting achieved consensus on a strategy for the prevention and management of chronic disease that includes the following: 1. Focus on behavioural change as the core component of all clinical programs for the prevention and management of chronic disease. 2. Establish actual centres to design, implement, study, and improve preventive programs for chronic disease. 3. Use human-centered design in the creation of prevention programs with an inclination to action, rapid prototyping and multiple iterations. 4. Extend the knowledge and skills of Sports and Exercise Medicine (SEM) professionals to build new programs for the prevention and treatment of chronic disease focused on physical activity, diet and lifestyle. 5. Mobilize resources and leverage networks to scale and distribute programs of prevention. True innovation lies in the ability to align thinking around these core strategies to ensure successful implementation of NCD prevention and management programs within health care. The IOC and SEM community are in an ideal position to lead this disruptive change. The outcome of the consensus meeting was the creation of the IOC Non-Communicable Diseases ad-hoc Working Group charged with the responsibility of moving this

Prevention and management of non-communicable disease: the IOC consensus statement, Lausanne 2013.

PubMed

Matheson, Gordon O; Klügl, Martin; Engebretsen, Lars; Bendiksen, Fredrik; Blair, Steven N; Börjesson, Mats; Budgett, Richard; Derman, Wayne; Erdener, Ugur; Ioannidis, John P A; Khan, Karim M; Martinez, Rodrigo; Van Mechelen, Willem; Mountjoy, Margo; Sallis, Robert E; Schwellnus, Martin; Shultz, Rebecca; Soligard, Torbjørn; Steffen, Kathrin; Sundberg, Carl Johan; Weiler, Richard; Ljungqvist, Arne

2013-11-01

Morbidity and mortality from preventable, non-communicable chronic disease (NCD) threatens the health of our populations and our economies. The accumulation of vast amounts of scientific knowledge has done little to change this. New and innovative thinking is essential to foster new creative approaches that leverage and integrate evidence through the support of big data, technology and design thinking. The purpose of this paper is to summarise the results of a consensus meeting on NCD prevention sponsored by the IOC in April 2013. Within the context of advocacy for multifaceted systems change, the IOC's focus is to create solutions that gain traction within healthcare systems. The group of participants attending the meeting achieved consensus on a strategy for the prevention and management of chronic disease that includes the following: (1) Focus on behavioural change as the core component of all clinical programmes for the prevention and management of chronic disease. (2) Establish actual centres to design, implement, study and improve preventive programmes for chronic disease. (3) Use human-centred design in the creation of prevention programmes with an inclination to action, rapid prototyping and multiple iterations. (4) Extend the knowledge and skills of Sports and Exercise Medicine (SEM) professionals to build new programmes for the prevention and treatment of chronic disease focused on physical activity, diet and lifestyle. (5) Mobilise resources and leverage networks to scale and distribute programmes of prevention. True innovation lies in the ability to align thinking around these core strategies to ensure successful implementation of NCD prevention and management programmes within healthcare. The IOC and SEM community are in an ideal position to lead this disruptive change. The outcome of the consensus meeting was the creation of the IOC Non-Communicable Diseases ad hoc Working Group charged with the responsibility of moving this agenda forward.

Delivery of health care for cardiovascular and metabolic diseases among people living with HIV/AIDS in African countries: a systematic review protocol.

PubMed

Watkins, David A; Tulloch, Nathaniel L; Anderson, Molly E; Barnhart, Scott; Steyn, Krisela; Levitt, Naomi S

2016-04-16

People living with HIV (PLHIV) in African countries are living longer due to the rollout of antiretroviral drug therapy programs, but they are at increasing risk of non-communicable diseases (NCDs). However, there remain many gaps in detecting and treating NCDs in African health systems, and little is known about how NCDs are being managed among PLHIV. Developing integrated chronic care models that effectively prevent and treat NCDs among PLHIV requires an understanding of the current patterns of care delivery and the major barriers and facilitators to health care. We present a systematic review protocol to synthesize studies of healthcare delivery for an important subset of NCDs, cardiovascular and metabolic diseases (CMDs), among African PLHIV. We plan to search electronic databases and reference lists of relevant studies published in African settings from January 2003 to the present. Studies will be considered if they address one or both of our major objectives and focus on health care for one or more of six interrelated CMDs (ischemic heart disease, stroke, heart failure, hypertension, diabetes, and hyperlipidemia) in PLHIV. Our first objective will be to estimate proportions of CMD patients along the "cascade of care"-i.e., screened, diagnosed, aware of the diagnosis, initiated on treatment, adherent to treatment, and with controlled disease. Our second objective will be to identify unique barriers and facilitators to health care faced by PLHIV in African countries. For studies deemed eligible for inclusion, we will assess study quality and risk of bias using previously published criteria. We will extract study data using standardized instruments. We will meta-analyze quantitative data at each level of the cascade of care for each CMD (first objective). We will use meta-synthesis techniques to understand and integrate qualitative data on health-related behaviors (second objective). CMDs and other NCDs are becoming major health concerns for African PLHIV. The

#Globalhealth Twitter Conversations on #Malaria, #HIV, #TB, #NCDS, and #NTDS: a Cross-Sectional Analysis.

PubMed

Fung, Isaac Chun-Hai; Jackson, Ashley M; Ahweyevu, Jennifer O; Grizzle, Jordan H; Yin, Jingjing; Tse, Zion Tsz Ho; Liang, Hai; Sekandi, Juliet N; Fu, King-Wa

Advocates use the hashtag #GlobalHealth on Twitter to draw users' attention to prominent themes on global health, to harness their support, and to advocate for change. We aimed to describe #GlobalHealth tweets pertinent to given major health issues. Tweets containing the hashtag #GlobalHealth (N = 157,951) from January 1, 2014, to April 30, 2015, were purchased from GNIP Inc. We extracted 5 subcorpora of tweets, each with 1 of 5 co-occurring disease-specific hashtags (#Malaria, #HIV, #TB, #NCDS, and #NTDS) for further analysis. Unsupervised machine learning was applied to each subcorpus to categorize the tweets by their underlying topics and obtain the representative tweets of each topic. The topics were grouped into 1 of 4 themes (advocacy; epidemiological information; prevention, control, and treatment; societal impact) or miscellaneous. Manual categorization of most frequent users was performed. Time zones of users were analyzed. In the entire #GlobalHealth corpus (N = 157,951), there were 40,266 unique users, 85,168 retweets, and 13,107 unique co-occurring hashtags. Of the 13,087 tweets across the 5 subcorpora with co-occurring hashtag #malaria (n = 3640), #HIV (n = 3557), #NCDS (noncommunicable diseases; n = 2373), #TB (tuberculosis; n = 1781), and #NTDS (neglected tropical diseases; n = 1736), the most prevalent theme was prevention, control, and treatment (4339, 33.16%), followed by advocacy (3706, 28.32%), epidemiological information (1803, 13.78%), and societal impact (1617, 12.36%). Among the top 10 users who tweeted the highest number of tweets in the #GlobalHealth corpus, 5 were individual professionals, 3 were news media, and 2 were organizations advocating for global health. The most common users' time zone was Eastern Time (United States and Canada). This study highlighted the specific #GlobalHealth Twitter conversations pertinent to malaria, HIV, tuberculosis, noncommunicable diseases, and neglected tropical diseases. These

[Provincial representativeness assessment of China Non-communicable and Chronic Disease Risk Factor Surveillance System in 2013].

PubMed

Zhao, Z P; Wang, L M; Li, Y C; Jiang, Y; Zhang, M; Huang, Z J; Zhang, X; Li, C; Zhou, M G

2018-02-06

Objective: To evaluate the provincial representativeness of China Non-communicable and Chronic Disease Risk Factor Surveillance System, 2013. Methods: The Sixth National Population Census data which was collected by National Bureau of Statistics of People's Republic of China was used to calculate proportion of population who aged 65 and above, mortality rate, the proportion of non-agriculture population, the illiteracy rate and urbanization rate in order to evaluate the surveillance system in each province. The Mann-Whitney U test was used to determine the statistically differences between the surveillance system and corresponding general population. Results: Among the 298 disease surveillance points (DSPs) in China Non-communicable and Chronic Disease Risk Factor Surveillance System, there were 111, 85, and 102 DSPs located in the east, middle, and west area of China, which covering 13.90%, 11.48%, and 12.28% of the total population, respectively. The surveillance system covered 169 million of the population of China, accounting for 12.70% of Chinese population. The number of DSPs by provinces ranges from 6 (Hainan, Qinghai, and Ningxia) to 14 (Shandong, Guangdong and Henan). It indicated that mortality rate (DSP: 0.238%; Province: 0.482%) and the illiteracy rate (DSP: 15.54%; Province: 26.22%) among DSPs in Tibet were significantly lower than the provincial level, on the other hand, the proportion of non-agriculture population among DSPs (40.6%) was significantly higher than the provincial level (18.8%). The urbanization rate among Jiangxi DSPs (43.4%) was significantly lower than the provincial level (59.9%). The proportion of non-agriculture population among Shandong DSPs (32.8%) was significantly higher than the provincial level (24.2%), however, the illiteracy rate among Shandong DSPs (3.86%) was significantly lower than the provincial level (5.25%). Other than the provinces mentioned above, there was no statistical differences ( P> 0.05) among proportions of

Integrating cardiovascular diseases, hypertension, and diabetes with HIV services: a systematic review.

PubMed

Haldane, Victoria; Legido-Quigley, Helena; Chuah, Fiona Leh Hoon; Sigfrid, Louise; Murphy, Georgina; Ong, Suan Ee; Cervero-Liceras, Francisco; Watt, Nicola; Balabanova, Dina; Hogarth, Sue; Maimaris, Will; Buse, Kent; McKee, Martin; Piot, Peter; Perel, Pablo

2018-01-01

Non-communicable diseases (NCDs), including cardiovascular diseases (CVD), hypertension and diabetes together with HIV infection are among the major public health concerns worldwide. Health services for HIV and NCDs require health systems that provide for people's chronic care needs, which present an opportunity to coordinate efforts and create synergies between programs to benefit people living with HIV and/or AIDS and NCDs. This review included studies that reported service integration for HIV and/or AIDS with coronary heart diseases, chronic CVD, cerebrovascular diseases (stroke), hypertension or diabetes. We searched multiple databases from inception until October 2015. Articles were screened independently by two reviewers and assessed for risk of bias. 11,057 records were identified with 7,616 after duplicate removal. After screening titles and abstracts, 14 papers addressing 17 distinct interventions met the inclusion criteria. We categorized integration models by diseases (HIV with diabetes, HIV with hypertension and diabetes, HIV with CVD and finally HIV with hypertension and CVD and diabetes). Models also looked at integration from micro (patient focused integration) to macro (system level integrations). Most reported integration of hypertension and diabetes with HIV and AIDS services and described multidisciplinary collaboration, shared protocols, and incorporating screening activities into community campaigns. Integration took place exclusively at the meso-level, with no micro- or macro-level integrations described. Most were descriptive studies, with one cohort study reporting evaluative outcomes. Several innovative initiatives were identified and studies showed that CVD and HIV service integration is feasible. Integration should build on existing protocols and use the community as a locus for advocacy and health services, while promoting multidisciplinary teams, including greater involvement of pharmacists. There is a need for robust and well

[Assessment of capacity for chronic noncommunicable diseases prevention and control of the Center for Disease Control and Prevention Organizations in China].

PubMed

Yin, Xiang-jun; Shi, Xiao-ming; Si, Xiang; Gao, Xin; Zhai, Yi

2010-10-01

To evaluate the capacity for noncommunicable diseases (NCDs) prevention and control in the Centers for Disease Control and Prevention (CDCs) in China. All CDCs in China, including provincial, city and county CDCs were surveyed by questionnaires designed by China CDC including resource provided, capacity and efforts for NCDs. (1) RESOURCE: 7483 staff members worked on NCDs prevention and control, only accounting for 4.0% of all the CDCs' personnel; 23.6% of the staff members devoted their time to NCDs control less than 6 months in 2008. Fundings for NCDs prevention and control only accounted for 2.29%, 1.70% and 2.69% of the total funds of provincial, city and county CDCs, respectively. (2) Capacity: The proportions of CDCs that had professional institutes of NCD at provincial, city and county level were 100.0%, 62.8% and 43.7% respectively. CDCs mainly cooperated with health agencies regarding NCDs prevention and control programs. 34.7% of the staff members had educational background of college undergraduate or higher, 12.1% had senior professional titles, 61.7% of them worked for NCDs less than 5 years. The average person-times of continuing education in NCDs were 21.90, 4.60 and 1.68 at the provincial, city and county CDCs respectively. 8.7% of the CDCs sent their staff members for advanced studies on NCDs. All provincial CDCs carried out surveillance but only 4.2% of them published reports of NCDs in all the CDCs during the past three years. (3) Efforts: 43.5% and 30.8% of the county CDCs carried out surveillance and intervention of NCDs respectively in 2008. RESOURCEs for NCDs prevention and control were quite limited in CDCs. Fundings and staff members for NCDs were not enough, compared to the heavy disease burden of NCDs. Capacity for NCDs prevention and control need to be improved.

Is Walk Score associated with hospital admissions from chronic diseases? Evidence from a cross-sectional study in a high socioeconomic status Australian city-state

PubMed Central

Mazumdar, Soumya; Learnihan, Vincent; Cochrane, Thomas; Phung, Hai; O'Connor, Bridget; Davey, Rachel

2016-01-01

Objectives To explore patterns of non-communicable diseases (NCDs) in the Australian Capital Territory (ACT).To ascertain the effect of the neighbourhood built environmental features and especially walkability on health outcomes, specifically for hospital admissions from NCDs. Design A cross-sectional analysis of public hospital episode data (2007–2013). Setting Hospitalisations from the ACT, Australia at very small geographic areas. Participants Secondary data on 75 290 unique hospital episodes representing 39 851 patients who were admitted to ACT hospitals from 2007 to 2013. No restrictions on age, sex or ethnicity. Main exposure measures Geographic Information System derived or compatible measures of general practitioner access, neighbourhood socioeconomic status, alcohol access, exposure to traffic and Walk Score walkability. Main outcome measures Hospitalisations of circulatory diseases, specific endocrine, nutritional and metabolic diseases, respiratory diseases and specific cancers. Results Geographic clusters with significant high and low risks of NCDs were found that displayed an overall geographic pattern of high risk in the outlying suburbs of the territory. Significant relationships between neighbourhood walkability as measured by Walk Score and the likelihood of hospitalisation with a primary diagnosis of myocardial infarction (heart attack) were found. A possible relationship was also found with the likelihood of being hospitalised with 4 major lifestyle-related cancers. Conclusions Our research augments the growing literature underscoring the relationships between the built environment and health outcomes. In addition, it supports the importance of walkable neighbourhoods, as measured by Walk Score, for improved health. PMID:27932340

Managing population health to prevent and detect cancer and non-communicable diseases.

PubMed

Bryant, Heather; Shin, Hai Rim; Forman, David; Stevanovic, Vladimir; Park, Sohee; Burton, Robert; Varghese, Cherian; Ullrich, Andreas; Sutcliffe, Catherine; Sutcliffe, Simon

2012-01-01

The goals of cancer control strategies are generally uniform across all constituencies and are to reduce cancer incidence, reduce cancer mortality, and improve quality of life for those affected by cancer. A well-constructed strategy will ensure that all of its elements can ultimately be connected to one of these goals. When a cancer control strategy is being implemented, it is essential to map progress towards these goals; without mapping progress, it is impossible to assess which components of the strategy require more attention or resources and which are not having the desired effect and need to be re-evaluated. In order to monitor and evaluate these strategies, systems need to be put in place to collect data and the appropriate indicators of performance need to be identified. Session 2 of the 4th International Cancer Control Congress (ICCC-4) focused on how to manage population health to prevent and detect cancers and non-communicable diseases through two plenary presentations and four interactive workshop discussions: 1) registries, measurement, and management in cancer control; 2) use of information for planning and evaluating screening and early detection programs; 3) alternative models for promoting community health, integrated care and illness management; and 4) control of non-communicable diseases. Workshop discussions highlighted that population based cancer registries are fundamental to understanding the cancer burden within a country. However, many countries in Africa, Asia, and South/ Central America do not have them in place. A new global initiative is underway, which brings together several international agencies, and aims to establish six IARC regional registration resource centres over the next five years. These will provide training, support, infrastructure and advocacy to local networks of cancer registries, and, it is hoped, improve the host countries' ability to assess and act on cancer issues within their jurisdictions. Multiple methods of

[Management programs on diabetes among Chinese adults in the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases].

PubMed

Jin, R R; Li, J J; Zhang, J; Li, J L; Bian, F; Deng, G J; Ma, S; Su, X W; Zhao, J; Jiang, Y

2018-04-10

Objective: To understand the current situation on management of diabetes mellitus patients aged 35 and above in the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases, in China. Methods: Local residents, aged 18 years and above were randomly selected by a complex, multistage, probability sampling method. Face-to-face questionnaire survey was carried out between November and December 2016. Rates regarding prevalence, treatment and management of diabetes were calculated, and influencing factors of diabetes were analyzed by using the non-conditional logistic regression model. Results: A total of 3 213 residents aged ≥35 years were included in this study, of which 11.48% (369/3 213) reported that they had ever been informed by a doctor or other health worker that their blood sugar level was high or being diabetic. The rate of self-reported treatment among the diabetic patients was 83.20% (307/369). Rates on overall management and standardized management were 69.92% (258/369) and 53.66% (198/369), respectively. Higher rates were seen in residents aged 55 to 64 years, 76.32% for overall management and 59.65% for standardized management. Through multiple logistic regression analysis, we found that standardized management for diabetes was much higher in the Demonstration Areas located in the eastern areas ( OR =2.942, 95% CI : 1.547-5.594), or patients with characteristics including high implementation score ( OR =3.499, 95% CI : 1.865-6.563), already signed family doctors ( OR =5.661, 95% CI : 3.237-9.899), or without hypertension ( OR =1.717, 95% CI : 1.010- 2.920). Residents who were living in the first and second batch areas of implementation or responding to the NCDs with positive attitude were more likely to accept standardized management. Conclusion: Prevention and management programs on diabetes had met the requirements set for the Demonstration Areas which had promoted the specific implementation and further

Prevalence of non-communicable disease risk factors in three sites across Papua New Guinea: a cross-sectional study

PubMed Central

Rarau, Patricia; Vengiau, Gwendalyn; Gouda, Hebe; Phuanukoonon, Suparat; Kevau, Isi H; Bullen, Chris; Scragg, Robert; Riley, Ian; Marks, Geoffrey; Umezaki, Masahiro; Morita, Ayako; Oldenburg, Brian; McPake, Barbara; Pulford, Justin

2017-01-01

Papua New Guinea (PNG) is a culturally, environmentally and ethnically diverse country of 7.3 million people experiencing rapid economic development and social change. Such development is typically associated with an increase in non-communicable disease (NCD) risk factors. Aim To establish the prevalence of NCD risk factors in three different regions across PNG in order to guide appropriate prevention and control measures. Methods A cross-sectional survey was undertaken with randomly selected adults (15–65 years), stratified by age and sex recruited from the general population of integrated Health and Demographic Surveillance Sites in West Hiri (periurban), Asaro (rural highland) and Karkar Island (rural island), PNG. A modified WHO STEPS risk factor survey was administered along with anthropometric and biochemical measures on study participants. Results The prevalence of NCD risk factors was markedly different across the three sites. For example, the prevalences of current alcohol consumption at 43% (95% CI 35 to 52), stress at 46% (95% CI 40 to 52), obesity at 22% (95% CI 18 to 28), hypertension at 22% (95% CI 17 to 28), elevated levels of cholesterol at 24% (95% CI 19 to 29) and haemoglobin A1c at 34% (95% CI 29 to 41) were highest in West Hiri relative to the rural areas. However, central obesity at 90% (95% CI 86 to 93) and prehypertension at 55% (95% CI 42 to 62) were most common in Asaro whereas prevalences of smoking, physical inactivity and low high-density lipoprotein-cholesterol levels at 52% (95% CI 45 to 59), 34% (95% CI 26 to 42) and 62% (95% CI 56 to 68), respectively, were highest in Karkar Island. Conclusion Adult residents in the three different communities are at high risk of developing NCDs, especially the West Hiri periurban population. There is an urgent need for appropriate multisectoral preventive interventions and improved health services. Improved monitoring and control of NCD risk factors is also needed in all regions across PNG

Comprehensive assessment of health education and health promotion in five non-communicable disease demonstration districts in China: a cross-sectional study.

PubMed

Xu, Qiaohua; Huang, Yuelong; Chen, Biyun

2017-12-26

This study aims to develop assessment indicators of health education and promotion for non-communicable disease (NCD) demonstration districts in China and to identify significant factors associated with NCD health education and promotion work. Three complementary techniques were used to conduct this study in Hunan Province, China, between late 2013 and 2015. The Delphi technique was used to develop weighted assessment indicators, followed by the rank sum ratio (RSR) to normalise the weights through rank conversion. Lastly, the technique for order of preference by similarity to ideal solution was conducted to assess five randomly selected NCD demonstration districts representing five different orientations in the province. A total of 24 assessment indicators were constructed covering the following sections: organisational management, fund support, personnel supplies, health education and promotion, people's awareness of NCDs, management and control of patients with NCD, satisfaction with health education and promotion and health literacy of residents. Five districts were selected as samples for evaluation (Furong District, Ziyang District, Shaodong County, Shuangfeng County and Luxi County). Performance varied among the sites, with Furong District greatly surpassing the other sites, especially in fund support, media promotion, technical support for publicity materials, community promotion and supportive environment supplies. The latter four factors were also much greater in the second-ranked Luxi County site than those in the other sites (except Furong District). There were gaps in health education and promotion work in NCD demonstration districts in Hunan Province. The districts that performed better had obvious advantages in fund support, media promotion, technical support, community promotion and supportive environment supplies. Our study provided both a methodological reference and an assessment indicator framework for similar future studies. © Article author

Piezo electric polaron and polaron pinning in n-CdS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nagasaka, K.

1976-05-01

The cyclotron resonance of the piezoelectric polaron in n-CdS has been investigated using far infrared spectroscopy at magnetic fields to 90 kOe. Both lamellar grating and Michelson Fourier transform spectrometers were used with a 0.3/sup 0/K Ge bolometer to study the photon energy region from 10 cm/sup -1/ to 60 cm/sup -1/. The theory of Miyake predicts that the frequency of the polaron's cyclotron resonance is shifted from the bare hand electron resonance frequency according to the expression: ..delta omega../sup p//sub c// ..cap omega../sub c/ varies as H/sup -1/ T/sup /sup 2///sup 3//. The magnetic field dependence of the presentmore » cyclotron resonance confirms this expression; the cyclotron mass isiezoelectric polaron effects. The bare band mass in n-CdS has also been determined by taking into account the Froehlich polaron interaction in addition to the piezoelectric polaron effects. For H parallel to the c-axis this cyclotron mass is 0.155 +- 0.005 m. The polaron pinning due to the 43 cm/sup -1/ optically inactive phonon has been observed.« less

A Global Cancer Surveillance Framework Within Noncommunicable Disease Surveillance: Making the Case for Population-Based Cancer Registries.

PubMed

Piñeros, Marion; Znaor, Ariana; Mery, Les; Bray, Freddie

2017-01-01

The growing burden of cancer among several major noncommunicable diseases (NCDs) requires national implementation of tailored public health surveillance. For many emerging economies where emphasis has traditionally been placed on the surveillance of communicable diseases, it is critical to understand the specificities of NCD surveillance and, within it, of cancer surveillance. We propose a general framework for cancer surveillance that permits monitoring the core components of cancer control. We examine communalities in approaches to the surveillance of other major NCDs as well as communicable diseases, illustrating key differences in the function, coverage, and reporting in each system. Although risk factor surveys and vital statistics registration are the foundation of surveillance of NCDs, population-based cancer registries play a unique fundamental role specific to cancer surveillance, providing indicators of population-based incidence and survival. With an onus now placed on governments to collect these data as part of the monitoring of NCD targets, the integration of cancer registries into existing and future NCD surveillance strategies is a vital requirement in all countries worldwide. The Global Initiative for Cancer Registry Development, endorsed by the World Health Organization, provides a means to enhance cancer surveillance capacity in low- and middle-income countries. © The Author 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The experiences of patients and carers living.

PubMed

Leeder, Stephen R; Jowsey, Tanisha; McNab, Justin W

2018-01-01

Non-communicable diseases (NCDs) are increasing in prevalence and straining health systems globally. This creates a so-called 'burden of disease', which can be traced in terms of fiscal health system matters and in terms of quality of life and lived experiences of people with NCDs. The United Nations has called for a global agenda to manage NCDs and reduce their burden. The purpose of this article is to summarise key findings from the Serious and Continuing Illness Policy and Practice Study concerning patients’ and carers’ experiences of multimorbid NCDs in Australia. We focus on the relevance of findings for policy and general practitioners in Australia. We suggest that a complex multimorbidity policy is needed to contextualise and guide single-illness NCD policies. Our research suggests that specialist NCD nurses and allied health professionals could have important roles in improving care coordination between general practices and community health centres.

Effect of genomics-related literacy on non-communicable diseases.

PubMed

Nakamura, Sho; Narimatsu, Hiroto; Katayama, Kayoko; Sho, Ri; Yoshioka, Takashi; Fukao, Akira; Kayama, Takamasa

2017-09-01

Recent progress in genomic research has raised expectations for the development of personalized preventive medicine, although genomics-related literacy of patients will be essential. Thus, enhancing genomics-related literacy is crucial, particularly for individuals with low genomics-related literacy because they might otherwise miss the opportunity to receive personalized preventive care. This should be especially emphasized when a lack of genomics-related literacy is associated with elevated disease risk, because patients could therefore be deprived of the added benefits of preventive interventions; however, whether such an association exists is unclear. Association between genomics-related literacy, calculated as the genomics literacy score (GLS), and the prevalence of non-communicable diseases was assessed using propensity score matching on 4646 participants (males: 1891; 40.7%). Notably, the low-GLS group (score below median) presented a higher risk of hypertension (relative risk (RR) 1.09, 95% confidence interval (CI) 1.03-1.16) and obesity (RR 1.11, 95% CI 1.01-1.22) than the high-GLS group. Our results suggest that a low level of genomics-related literacy could represent a risk factor for hypertension and obesity. Evaluating genomics-related literacy could be used to identify a more appropriate population for health and educational interventions.

Improving access to medicines for non-communicable diseases in rural India: a mixed methods study protocol using quasi-experimental design.

PubMed

Prashanth, N S; Elias, Maya Annie; Pati, Manoj Kumar; Aivalli, Praveenkumar; Munegowda, C M; Bhanuprakash, Srinath; Sadhana, S M; Criel, Bart; Bigdeli, Maryam; Devadasan, Narayanan

2016-08-22

India has the distinction of financing its healthcare mainly through out-of-pocket expenses by individual families contributing to catastrophic health expenditure and impoverishment. Nearly 70 % of the expenditure is on medicines purchased at private pharmacies. Patients with chronic ailments are especially affected, as they often need lifelong medicines. Over the past years in India, there have been several efforts to improve drug availability at government primary health centres. In this study, we aim to understand health system factors that affect utilisation and access to generic medicines for people with non-communicable diseases. This study aims to understand if (and how) a package of interventions targeting primary health centres and community participation platforms affect utilisation and access to generic medicines for people with non-communicable diseases in the current district context in India. This study will employ a quasi-experimental design and a qualitative theory-driven approach. PHCs will be randomly assigned to one of three arms of the intervention. In one arm, PHCs will receive inputs to optimise service delivery for non-communicable diseases, while the second arm will receive an additional package of interventions to strengthen community participation platforms for improving non-communicable disease care. The third arm will be the control. We will conduct household and facility surveys, before and after the intervention and will estimate the effect of the intervention by difference-in-difference analysis. Sample size for measuring effects was calculated based on obtaining at least 30 households for each primary health centre spread across three distance-based clusters. Primary outcomes include availability and utilisation of medicines at primary health centres and out-of-pocket expenditure for medicines by non-communicable disease households. Focus group discussions with patients and in-depth interviews with health workers will also be

[Surveillance of risk factors for non-communicable diseases among adolescents: the experience in Rio de Janeiro, Brazil].

PubMed

Castro, Inês Rugani Ribeiro de; Cardoso, Letícia Oliveira; Engstrom, Elyne Montenegro; Levy, Renata Bertazzi; Monteiro, Carlos Augusto

2008-10-01

This paper presents the methodology and results of the implementation of a Surveillance System for Non-Communicable Disease Risk Factors in Adolescents. A random sample of 8th-grade students (n = 1,684) enrolled in municipal schools in Rio de Janeiro, Brazil, was studied. Students were asked to complete a confidential questionnaire on food consumption, physical activity, sedentary leisure-time activities, and tobacco consumption. Prevalence estimates of risk factors were calculated for the entire sample and by gender. Non-response rates ranged from 1.1 to 8.9%. The findings included low consumption of fruits (45.8%) and vegetables (20.0% and 16.5% for salads and cooked vegetables, respectively), regular consumption of soft drinks (36.7%) and candies (46.7%), extensive time on TV, computer, and videogames (71.7% spend at least 4h/day at these activities), low frequency of regular physical activity (40%), and 6.4% prevalence of smoking. Girls showed less physical activity and more smoking. The system appeared to be feasible and indicated high prevalence of risk factors for non-communicable diseases.

Predictors of health related quality of life in older people with non-communicable diseases attending three primary care clinics in Malaysia.

PubMed

Sazlina, S G; Zaiton, A; Nor Afiah, M Z; Hayati, K S

2012-05-01

To determine the health related quality of life and its predictive factors among older people with non-communicable diseases attending primary care clinics. Cross-sectional study. Three public primary care clinics in a district in Selangor, Malaysia. Registered patients aged 55 years and above. A face-to-face interview was conducted using a validated questionnaire of Medical Outcome Study 36-item short form health survey (SF-36). The outcome measure was the health related quality of life (HRQoL) and other factors measured were socio demography, physical activity, social support (Duke-UNC Functional Social Support Questionnaire), and presence of non-communicable diseases. A total of 347 participants had non-communicable diseases which included hypertension (41.8%), type 2 diabetes (33.7%), asthma (4.8%), hyperlipidaemia (1.7%), coronary heart disease (1.2%), and osteoarthritis (0.2%). Age ≥ 65 years old (OR =2.23; 95%CI=1.42, 3.50), single (OR=1.75; 95%CI=1.06,2.90), presence of co-morbid condition (OR=1.66; 95%CI=1.06, 2.61), and poorer social support (OR=2.11; 95%CI=1.27, 3.51; p=0.002) were significant predictors of poorer physical component of HRQoL . In predicting lower mental health component of HRQoL, the significant predictors were women (OR=2.28; 95%CI=1.44, 3.62), Indian ethnicity (OR=1.86; 95%CI=1.08, 3.21) and poorer social support (OR=2.71; 95%CI=1.63, 4.51). No interactions existed between these predictors. Older people with non-communicable diseases were susceptible to lower health related quality of life. Increasing age, single, presence of co-morbid conditions, and poorer social support were predictors of lower physical health component of HRQoL. While the older women, Indian ethnicity and poorer social support reported lower mental health component of HRQoL.

Realizing the Potential of Adolescence to Prevent Transgenerational Conditioning of Noncommunicable Disease Risk: Multi-Sectoral Design Frameworks

PubMed Central

Bay, Jacquie L.; Morton, Susan M.; Vickers, Mark H.

2016-01-01

Evidence from the field of Developmental Origins of Health and Disease (DOHaD) demonstrates that early life environmental exposures impact later-life risk of non-communicable diseases (NCDs). This has revealed the transgenerational nature of NCD risk, thus demonstrating that interventions to improve environmental exposures during early life offer important potential for primary prevention of DOHaD-related NCDs. Based on this evidence, the prospect of multi-sectoral approaches to enable primary NCD risk reduction has been highlighted in major international reports. It is agreed that pregnancy, lactation and early childhood offer significant intervention opportunities. However, the importance of interventions that establish positive behaviors impacting nutritional and non-nutritional environmental exposures in the pre-conceptual period in both males and females, thus capturing the full potential of DOHaD, must not be overlooked. Adolescence, a period where life-long health-related behaviors are established, is therefore an important life-stage for DOHaD-informed intervention. DOHaD evidence underpinning this potential is well documented. However, there is a gap in the literature with respect to combined application of theoretical evidence from science, education and public health to inform intervention design. This paper addresses this gap, presenting a review of evidence informing theoretical frameworks for adolescent DOHaD interventions that is accessible collectively to all relevant sectors. PMID:27417627

Intervention strategies to reduce the burden of non-communicable diseases in Mexico: cost effectiveness analysis

PubMed Central

Carvalho, Natalie; Gutiérrez-Delgado, Cristina; Orozco, Ricardo; Mancuso, Anna; Hogan, Daniel R; Lee, Diana; Murakami, Yuki; Sridharan, Lakshmi; Medina-Mora, María Elena; González-Pier, Eduardo

2012-01-01

Objective To inform decision making regarding intervention strategies against non-communicable diseases in Mexico, in the context of health reform. Design Cost effectiveness analysis based on epidemiological modelling. Interventions 101 intervention strategies relating to nine major clusters of non-communicable disease: depression, heavy alcohol use, tobacco use, cataracts, breast cancer, cervical cancer, chronic obstructive pulmonary disease, cardiovascular disease, and diabetes. Data sources Mexican data sources were used for most key input parameters, including administrative registries; disease burden and population estimates; household surveys; and drug price databases. These sources were supplemented as needed with estimates for Mexico from the WHO-CHOICE unit cost database or with estimates extrapolated from the published literature. Main outcome measures Population health outcomes, measured in disability adjusted life years (DALYs); costs in 2005 international dollars ($Int); and costs per DALY. Results Across 101 intervention strategies examined in this study, average yearly costs at the population level would range from around ≤$Int1m (such as for cataract surgeries) to >$Int1bn for certain strategies for primary prevention in cardiovascular disease. Wide variation also appeared in total population health benefits, from <1000 DALYs averted a year (for some components of cancer treatments or aspirin for acute ischaemic stroke) to >300 000 averted DALYs (for aggressive combinations of interventions to deal with alcohol use or cardiovascular risks). Interventions in this study spanned a wide range of average cost effectiveness ratios, differing by more than three orders of magnitude between the lowest and highest ratios. Overall, community and public health interventions such as non-personal interventions for alcohol use, tobacco use, and cardiovascular risks tended to have lower cost effectiveness ratios than many clinical interventions (of varying

Community health workers improve disease control and medication adherence among patients with diabetes and/or hypertension in Chiapas, Mexico: an observational stepped-wedge study

PubMed Central

Franke, Molly F; Arrieta, Jafet; Carrasco, Hector; Elliott, Patrick; Flores, Hugo; Friedman, Alexandra; Graham, Sophia; Martinez, Luis; Palazuelos, Lindsay; Savage, Kevin; Tymeson, Hayley; Palazuelos, Daniel

2018-01-01

Background Non-communicable diseases (NCDs) contribute greatly to morbidity and mortality in low-income and middle-income countries (LMICs). Community health workers (CHWs) may improve disease control and medication adherence among patients with NCDs in LMICs, but data are lacking. We assessed the impact of a CHW-led intervention on disease control and adherence among patients with diabetes and/or hypertension in Chiapas, Mexico. Methods We conducted a prospective observational study among adult patients with diabetes and/or hypertension, in the context of a stepped-wedge roll-out of a CHW-led intervention. We measured self-reported adherence to medications, blood pressure and haemoglobin A1c at baseline and every 3 months, timed just prior to expansion of the intervention to a new community. We conducted individual-level mixed effects analyses of study data, adjusting for time and clustering by patient and community. Findings We analysed 108 patients. The CHW-led intervention was associated with a twofold increase in the odds of disease control (OR 2.04, 95% CI 1.15 to 3.62). It was also associated with optimal adherence assessed by 30-day recall (OR 1.86; 95% CI 1.15 to 3.02) and a positive self-assessment of adherence behaviour (OR 2.29; 95% CI 1.26 to 4.15), but not by 5-day recall. Interpretation A CHW-led adherence intervention was associated with disease control and adherence among adults with diabetes and/or hypertension. This study supports a role of CHWs in supplementing comprehensive primary care for patients with NCDs in LMICs. Trial registration number NCT02549495. PMID:29527344

The National Action Plan for the Prevention and Control of Non-communicable Diseases and Health Promotion in Pakistan--Cardiovascular diseases.

PubMed

Nishtar, Sania; Faruqui, Azhar M A; Mattu, Mohamad A; Mohamud, Khalif Bile; Ahmed, Ashfaq

2004-12-01

The National Action Plan for Non-Communicable Disease Prevention, Control and Health Promotion in Pakistan (NAP-NCD) incorporates prevention and control of cardiovascular diseases (CVD) as part of a comprehensive and integrated non-communicable Disease (NCD) prevention effort. In this programme, surveillance of cardiovascular risk factors is part of an integrated population-based NCD surveillance system. The population approach to CVD prevention is a priority area in this programme with a focus on broad policy measures and behavioural change communication. The former include revision of the current policy on diet and nutrition to expand its focus on under-nutrition; the development of a physical activity policy; strategies to limit the production of, and access to, ghee as a medium for cooking and agricultural and fiscal policies that increase the demand for, and make healthy food more accessible. The programme focuses attention on improving the quality of prevention programmes within primary and basic health sites and integrates concerted primary and secondary prevention programmes into health services as part of a comprehensive and sustainable, scientifically valid, and resource-sensitive programme for all categories of healthcare providers. It promotes screening for raised blood pressure at the population level and screening for dyslipidaemia and diabetes in high-risk groups only. It highlights the need to ensure the availability of aspirin, beta blockers, thiazides, ACE inhibitors, statins and penicillin at all levels of healthcare. The programme points out the need to conduct clinical end-point trials in the native Pakistani setting to define cost-effective therapeutic strategies for primary and secondary prevention of CVDs. Emphasis is laid on building capacity of health systems in support of CVD prevention and control and building a coalition or network of organizations to add momentum to CVD prevention and control efforts.

Preventing non-communicable disease in Oman, a legislative review.

PubMed

Al-Bahlani, Sabah; Mabry, Ruth

2014-06-01

The burden of non-communicable disease (NCD) is a major global concern and is projected to increase by 15% over the next 10 years. NCD is the leading cause of mortality in Oman and other countries of the Gulf Cooperation Council (GCC). Some of the most successful interventions to address NCD include legislations like banning smoking in public places. A desk review of available policies and legislations related to the behavioural risk factors of NCD from the GCC and from Oman was conducted with a focus on policies and legislations related to food, physical activity and tobacco. The review identified numerous documents; most were policies and resolutions related to tobacco control. Although only a few documents were laws, a majority were issued by non-health sectors. This policy review is the first effort in the GCC to consolidate information on the regulatory framework for the three key risk behaviours in the region, tobacco use, unhealthy diet and physical inactivity. Further work is needed to strengthen the regulatory framework, at both the national and regional levels, to strengthen tobacco control as well as to improve dietary patterns and physical activity levels. Given that a bulk of laws, regulations and policies are beyond the scope of the health sector, significant advocacy efforts are required to generate a multisectoral response. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

An overview of salt intake reduction efforts in the Gulf Cooperation Council countries.

PubMed

Alhamad, Nawal; Almalt, Elsayed; Alamir, Najeeba; Subhakaran, Monica

2015-06-01

Globally, morbidity and mortality from non-communicable diseases (NCDs) are increasing steadily and at an alarming rate. High blood pressure is a major risk factor for cardiovascular disease (CVD) and salt reduction is an effective measure to decrease mortality rates. In the Eastern Mediterranean region, current salt intake is high, with an average intake of >12 g per person per day. Reducing the intake of salt has been identified as a priority intervention to reduce NCDs. Countries of the Gulf Cooperation Council (GCC) are showing a willingness to comply with the World Health Organization (WHO) recommendations and an eagerness to reduce the burden of NCDs. However, they face some challenges, including lack of political commitment, lack of experience, and shortage of qualified human resources. Salt intake reduction efforts vary in the GCC region, from achieving 20% salt reduction in bread, to the very early stages of planning.

An overview of salt intake reduction efforts in the Gulf Cooperation Council countries

PubMed Central

Almalt, Elsayed; Alamir, Najeeba; Subhakaran, Monica

2015-01-01

Globally, morbidity and mortality from non-communicable diseases (NCDs) are increasing steadily and at an alarming rate. High blood pressure is a major risk factor for cardiovascular disease (CVD) and salt reduction is an effective measure to decrease mortality rates. In the Eastern Mediterranean region, current salt intake is high, with an average intake of >12 g per person per day. Reducing the intake of salt has been identified as a priority intervention to reduce NCDs. Countries of the Gulf Cooperation Council (GCC) are showing a willingness to comply with the World Health Organization (WHO) recommendations and an eagerness to reduce the burden of NCDs. However, they face some challenges, including lack of political commitment, lack of experience, and shortage of qualified human resources. Salt intake reduction efforts vary in the GCC region, from achieving 20% salt reduction in bread, to the very early stages of planning. PMID:26090327

NTDs V.2.0: "blue marble health"--neglected tropical disease control and elimination in a shifting health policy landscape.

PubMed

Hotez, Peter J

2013-11-01

The concept of the neglected tropical diseases (NTDs) was established in the aftermath of the Millennium Development Goals. Here, we summarize the emergence of several new post-2010 global health documents and policies, and how they may alter the way we frame the world's major NTDs since they were first highlighted. These documents include a new Global Burden of Disease 2010 Study that identifies visceral leishmaniasis and food-borne trematode infections as priority diseases beyond the seven NTDs originally targeted by preventive chemotherapy, a London Declaration for access to essential medicines, and a 2013 World Health Assembly resolution on NTDs. Additional information highlights an emerging dengue fever pandemic. New United Nations resolutions on women and the non-communicable diseases (NCDs) have not yet embraced NTDs, which may actually be the most common afflictions of girls and women and represent a stealth cause of NCDs. NTDs also have important direct and collateral effects on HIV/AIDS and malaria, and there is now a robust evidence base and rationale for incorporating NTDs into the Global Fund to Fight AIDS, Tuberculosis, and Malaria. "Blue marble health" is an added concept that recognizes a paradoxical NTD disease burden among the poor living in G20 (Group of Twenty) and other wealthy countries, requiring these nations to take greater ownership for both disease control and research and development. As we advance past the year 2015, it will be essential to incorporate global NTD elimination into newly proposed Sustainable Development Goals.

The importance of early life in childhood obesity and related diseases: a report from the 2014 Gravida Strategic Summit.

PubMed

Macaulay, E C; Donovan, E L; Leask, M P; Bloomfield, F H; Vickers, M H; Dearden, P K; Baker, P N

2014-12-01

Obesity and its related non-communicable diseases (NCDs), such as type 2 diabetes, heart disease and cancer, impose huge burdens on society, particularly the healthcare system. Until recently, public health and policy were primarily focused on secondary prevention and treatment of NCDs. However, epidemiological and experimental evidence indicates that early-life exposures influence the risk of childhood obesity and related diseases later in life, and has now focused attention on the health of both mother and child. During pregnancy and the early neonatal period, individuals respond to their environment by establishing anatomical, physiological and biochemical trajectories that shape their future health. This period of developmental plasticity provides an early window of opportunity to mitigate the environmental insults that may increase an individual's sensitivity to, or risk of, developing obesity or related diseases later in life. Although much investigation has already occurred in the area of Developmental Origins of Health and Disease research, the science itself is still in its infancy. It remains for researchers to tackle the important outstanding questions and translate their knowledge into workable solutions for the public good. The challenge, however, is to decide which areas to focus on. With these opportunities and challenges in mind, the 2014 Gravida Summit convened to examine how its early-life research program can determine which areas of research into mechanisms, biomarkers and interventions could contribute to the international research strategy to fight childhood obesity and its related diseases.

Advanced glycation end products and their receptor in age-related, non-communicable chronic inflammatory diseases; Overview of clinical evidence and potential contributions to disease.

PubMed

Reynaert, Niki L; Gopal, Poornima; Rutten, Erica P A; Wouters, Emiel F M; Schalkwijk, Casper G

2016-12-01

Age-related, non-communicable chronic inflammatory diseases represent the major 21st century health problem. Especially in Western countries, the prevalence of non-communicable diseases like chronic obstructive pulmonary disease, cardiovascular disease, type 2 diabetes and osteoporosis are exponentially rising as the population ages. These diseases are determined by common risk factors and share an age-related onset. The affected organs display evidence of accelerated ageing, and are hallmarked by chronic inflammation and oxidative stress. The receptor for advanced glycation end products (RAGE) has been implicated in a number of inflammatory diseases and plays a central role in amplifying inflammatory responses. Advanced glycation end product (AGE) formation and accumulation is accelerated under these conditions. Advanced glycation end products are not only linked to RAGE signaling and inflammation, but to various hallmarks of the ageing process. In addition to these biological functions, circulating levels of the soluble form of RAGE and of advanced glycation end products are candidate biomarkers for many age-related inflammatory diseases. The purpose of this review is to provide an overview of the mechanistic connections between RAGE and advanced glycation end products and the processes of inflammation and ageing. Furthermore, through the presented overview of AGE-RAGE alterations that have been described in clinical studies in chronic obstructive pulmonary disease, cardiovascular disease, type 2 diabetes and osteoporosis, and insight obtained from mechanistic in vitro and animal studies, it can be concluded that these AGE-RAGE disturbances are a common contributing factor to the inflammatory state and pathogenesis of these various conditions. Copyright © 2016 Elsevier Ltd. All rights reserved.

Bioactive Peptide of Marine Origin for the Prevention and Treatment of Non-Communicable Diseases

PubMed Central

Pangestuti, Ratih; Kim, Se-Kwon

2017-01-01

Non-communicable diseases (NCD) are the leading cause of death and disability worldwide. The four main leading causes of NCD are cardiovascular diseases, cancers, respiratory diseases and diabetes. Recognizing the devastating impact of NCD, novel prevention and treatment strategies are extensively sought. Marine organisms are considered as an important source of bioactive peptides that can exert biological functions to prevent and treatment of NCD. Recent pharmacological investigations reported cardio protective, anticancer, antioxidative, anti-diabetic, and anti-obesity effects of marine-derived bioactive peptides. Moreover, there is available evidence supporting the utilization of marine organisms and its bioactive peptides to alleviate NCD. Marine-derived bioactive peptides are alternative sources for synthetic ingredients that can contribute to a consumer’s well-being, as a part of nutraceuticals and functional foods. This contribution focus on the bioactive peptides derived from marine organisms and elaborates its possible prevention and therapeutic roles in NCD. PMID:28282929

Policy environment for prevention, control and management of cardiovascular diseases in primary health care in Kenya.

PubMed

Asiki, Gershim; Shao, Shuai; Wainana, Carol; Khayeka-Wandabwa, Christopher; Haregu, Tilahun N; Juma, Pamela A; Mohammed, Shukri; Wambui, David; Gong, Enying; Yan, Lijing L; Kyobutungi, Catherine

2018-05-09

In Kenya, cardiovascular diseases (CVDs) accounted for more than 10% of total deaths and 4% of total Disability-Adjusted Life Years (DALYs) in 2015 with a steady increase over the past decade. The main objective of this paper was to review the existing policies and their content in relation to prevention, control and management of CVDs at primary health care (PHC) level in Kenya. A targeted document search in Google engine using keywords "Kenya national policy on cardiovascular diseases" and "Kenya national policy on non-communicable diseases (NCDs)" was conducted in addition to key informant interviews with Kenyan policy makers. Relevant regional and international policy documents were also included. The contents of documents identified were reviewed to assess how well they aligned with global health policies on CVD prevention, control and management. Thematic content analysis of the key informant interviews was also conducted to supplement the document reviews. A total of 17 documents were reviewed and three key informants interviewed. Besides the Tobacco Control Act (2007), all policy documents for CVD prevention, control and management were developed after 2013. The national policies were preceded by global initiatives and guidelines and were similar in content with the global policies. The Kenya health policy (2014-2030), The Kenya Health Sector Strategic and Investment Plan (2014-2018) and the Kenya National Strategy for the Prevention and Control of Non-communicable diseases (2015-2020) had strategies on NCDs including CVDs. Other policy documents for behavioral risk factors (The Tobacco Control Act 2007, Alcoholic Drinks Control (Licensing) Regulations (2010)) were available. The National Nutrition Action Plan (2012-2017) was available as a draft. Although Kenya has a tiered health care system comprising primary healthcare, integration of CVD prevention and control at PHC level was not explicitly mentioned in the policy documents. This review revealed

Baseline assessment of WHO's target for both availability and affordability of essential medicines to treat non-communicable diseases.

PubMed

Ewen, Margaret; Zweekhorst, Marjolein; Regeer, Barbara; Laing, Richard

2017-01-01

WHO has set a voluntary target of 80% availability of affordable essential medicines, including generics, to treat major non-communicable diseases (NCDs), in the public and private sectors of countries by 2025. We undertook a secondary analysis of data from 30 surveys in low- and middle-income countries, conducted from 2008-2015 using the World Health Organization (WHO)/Health Action International (HAI) medicine availability and price survey methodology, to establish a baseline for this target. Data for 49 medicines (lowest priced generics and originator brands) to treat cardiovascular diseases (CVD), diabetes, chronic obstructive pulmonary diseases (COPD) and central nervous system (CNS) conditions were analysed to determine their availability in healthcare facilities and pharmacies, their affordability for those on low incomes (based on median patient prices of each medicine), and the percentage of medicines that were both available and affordable. Affordability was expressed as the number of days' wages of the lowest-paid unskilled government worker needed to purchase 30 days' supply using standard treatment regimens. Paying more than 1 days' wages was considered unaffordable. In low-income countries, 15.2% and 18.9% of lowest-priced generics met WHO's target in the public and private sectors, respectively, and 2.6% and 5.2% of originator brands. In lower-middle income countries, 23.8% and 23.2% of lowest priced generics, and 0.8% and 1.4% of originator brands, met the target in the public and private sectors, respectively. In upper-middle income countries, the situation was better for generics but still suboptimal as 36.0% and 39.4% met the target in public and private sectors, respectively. For originator brands in upper-middle income countries, none reached the target in the public sector and 13.7% in the private sector. Across the therapeutic groups for lowest priced generics, CVD medicines in low-income countries (11.9%), and CNS medicines in lower

Language and communication non-pharmacological interventions in patients with Alzheimer's disease: a systematic review. Communication intervention in Alzheimer

PubMed Central

Morello, Aline Nunes da Cruz; Lima, Tatiane Machado; Brandão, Lenisa

2017-01-01

ABSTRACT Alzheimer's disease considerably compromises communication skills. Language changes become more prominent as the disease progresses. Deterioration of language and cognition reduces the ability of holding conversations, which has a negative impact on social interaction. OBJECTIVE: To conduct a systematic review of the literature for articles reporting interventions focused on the language and communication of people with Alzheimer's disease (AD) without use of medication. METHODS: We performed a search using the keywords Alzheimer's disease, language, communication, cognition, cognitive intervention, rehabilitation and therapy, and their corresponding Portuguese and Spanish terms, on the SciELO, LILACS, PubMed and PsychINFO databases. We analyzed intervention studies published from 1993 to 2016 that involved stimulation of language skills and/or communication with pre-and post-intervention quantitative results, and whose samples included at least 50% with a diagnosis of probable AD. Studies were analyzed and classified into four levels of evidence, according to the criteria described in the literature. RESULTS: Twenty-eight articles were included. The majority of the designs had medium-to-low scientific evidence. Most interventions showed benefits for at least one language or communicative skill. Eight types of interventions emerged from the analysis of the studies. Further research with higher levels of evidence is recommended in the investigation of interventions focused on language and communication skills of patients with dementia. CONCLUSION: Studies with high levels of evidence on the topic investigated are only being conducted on a small scale. Two intervention techniques seem potentially effective: lexical-semantic approaches and interventions that work with different cognitive skills (including language). PMID:29213519

"Boring" family routines reduce non-communicable diseases: a commentary and call for action.

PubMed

Rotheram-Borus, Mary Jane; Tomlinson, Mark; Davis, Emily

2015-01-01

As global donors shift their efforts from infectious diseases to non-communicable diseases (NCD), it is critical to capitalize on our prior mistakes and successes. Policy makers and public health administrators are often looking for magic bullets: drugs or treatments to eradicate disease. Yet, each potential magic bullet requires consistent, daily implementation and adherence to a new set of habits to actually work. Families' and communities' daily, interlocking routines will be the battlefield on which scientific and technological breakthroughs will be implemented and succeed or not. Currently, there are many evidence-based interventions (EBI) which have been demonstrated to shift specific habits which account for most NCD (eating, drinking, moving, and smoking). Yet, securing sustained uptake of these programs is rare - suggesting different intervention strategies are needed. Structural changes, policy nudges, and partnerships with private enterprise may be able to shift the health behaviors of more citizens faster and at a lower cost than existing EBI. Addressing concurrent risk and protective factors at the community level and intervening to shape new cultural routines may be useful to reduce NCD.

Access to medicines and distributive justice: breaching Doha's ethical threshold.

PubMed

Kiddell-Monroe, Rachel

2014-08-01

The global health crisis in non-communicable diseases (NCDs) reveals a deep global health inequity that lies at the heart of global justice concerns. Mirroring the HIV/AIDS epidemic, NCDs bring into stark relief once more the human consequences of trade policies that reinforce global inequities in treatment access. Recognising distributive justice issues in access to medicines for their populations, World Trade Organisation (WTO) members confirmed the primacy of access to medicines for all in trade and public health in the landmark Doha Declaration on the TRIPS Agreement and Public Health of 2001. © 2014 John Wiley & Sons Ltd.

Relationships between breast cancer and common non- communicable disease risk factors: an ecological study.

PubMed

Abbastabar, Hedayat; Hamidifard, Parvin; Roustazadeh, Abazar; Mousavi, Seyyed Hamid; Mohseni, Shokrallah; Sepandi, Mojtaba; Barouni, Mohsen; Alizadeh, Ali

2013-01-01

Breast cancer is one the most common cause of cancer-related deaths among women worldwide. The aims of this study were to investigate the impact of dietary factors and health status indicators on breast cancer (BC) incidence. Risk factor data (RFD) of 89,404 individuals (15-64 years old) were gathered by questionnaire and laboratory examinations through a cross sectional study from the Non- Communicable Disease Surveillance Centre (NCDSC) of Iran. BC incidences of all provinces through 2001-2006 segregated by age and gender were obtained from the Cancer Registry Ministry of Health (CRMH). A significant positive relationship was seen between diabetes mellitus, fish consumption, percent of academic education and non-consumption of fruit, and breast cancer in women. However, non fish consumption, percent age illiteracy and taking fruit showed a significant negative relationship with the incidence of breast cancer. In addition, multiple linear regression analysis showed associations among percentage with academic education, fruit consumption and diabetes. We conclude that dietary factors such as fish and fruit consumption, dairy products, health status indicators, academic education, and some diseases like diabetes mellitus can affect the BC incidence, although the results of ecologic studies like this must naturally be interpreted with caution.

Assessing the impact of general practitioner team service on perceived quality of care among patients with non-communicable diseases in China: a natural experimental study.

PubMed

Yin, Jia; Wei, Xiaolin; Li, Haitao; Jiang, Yanling; Mao, Chunfang

2016-10-01

China issued the national primary care policy of promoting general practitioner (GP) team service in 2011. We conducted this study to assess the impact of the GP team service on quality of primary care as perceived by patients with non-communicable diseases (NCDs). Natural experimental study. This study was conducted in Shanghai, where the policy was effectively implemented, and Kunming, where the policy was not implemented. In both cities, NCD patients were interviewed with primary care assessment tool (PCAT) after their clinical consultations in their community health centers. The implementation of GP team service policy. Multiple linear regressions were employed to compare PCAT scores between the two rounds of the surveys in each city. Difference-in-difference (DID) analysis was used to identify the changes between two cities over time. A total of 663 and 587 patients in Shanghai, and 400 and 441 patients in Kunming were surveyed in 2011 and 2013, respectively. The DID analysis showed that the total primary care quality scores improved in Shanghai compared with Kunming between 2011 and 2013 (β = 1.30, 95% CI: 0.74, 1.87). In Shanghai, care quality in 2013 improved significantly for the total score and the six components when compared with those in 2011. No significant changes were observed in Kunming in the same period. Primary care policies that promote long-term provider-patient relationships, coordinated service with hospitals and capitation payment for the GP team may contribute to the improvement of care quality in Shanghai. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The double burden of disease among mining workers in Papua, Indonesia: at the crossroads between Old and New health paradigms.

PubMed

Rodriguez-Fernandez, Rodrigo; Ng, Nawi; Susilo, Dwidjo; Prawira, John; Bangs, Michael J; Amiya, Rachel M

2016-09-08

As the global shift toward non-communicable diseases overlaps with the unfinished agenda of confronting infectious diseases in low- and middle-income countries, epidemiological links across both burdens must be recognized. This study examined the non-communicable disease-infectious disease overlap in the specific comorbidity rates for key diseases in an occupational cohort in Papua, Indonesia. Diagnosed cases of ischaemic heart disease, stroke, hypertension, diabetes (types 1 and 2), chronic obstructive pulmonary disease, asthma, cancer, HIV and AIDS, tuberculosis, and malaria were extracted from 22,550 patient records (21,513 men, 1037 women) stored in identical electronic health information systems from two clinic sites in Papua, Indonesia. Data were collected as International Classification of Diseases, 10th Revision, entries from records spanning January-December 2013. A novel application of Circos software was used to visualize the interconnectedness between the disease burdens as overlapping prevalence estimates representing comorbidities. Overall, NCDs represented 38 % of all disease cases, primarily in the form of type 2 diabetes (n = 1440) and hypertension (n = 1398). Malaria cases represented the largest single portion of the disease burden with 5310 recorded cases, followed by type 2 diabetes with 1400 cases. Tuberculosis occurred most frequently alongside malaria (29 %), followed by chronic obstructive pulmonary disease (19 %), asthma (17 %), and stroke (12 %). Hypertension-tuberculosis (4 %), tuberculosis-cancer (4 %), and asthma-tuberculosis (2 %) comorbidities were also observed. The high prevalence of multimorbidity, preponderance of non-communicable diseases, and extensive interweaving of non-communicable and infectious disease comorbidities highlighted in this cohort of mining workers in Papua, Indonesia reflect the markedly double disease burden increasingly plaguing Indonesia and other similar low- and middle-income countries - a

Non-communicable disease risk factor patterns among mining industry workers in Papua, Indonesia: longitudinal findings from the Cardiovascular Outcomes in a Papuan Population and Estimation of Risk (COPPER) Study

PubMed Central

Rodriguez-Fernandez, Rodrigo; Rahajeng, Ekowati; Viliani, Francesca; Kushadiwijaya, Haripurnomo; Amiya, Rachel M; Bangs, Michael J

2015-01-01

Objectives Non-communicable diseases (NCDs) constitute an increasing slice of the global burden of disease, with the South-East Asia region projected to see the highest increase in NCD-related deaths over the next decade. Mining industry employees may be exposed to various factors potentially elevating their NCD risk. This study aimed to assess the distribution and 5-year longitudinal trends of key metabolic NCD risk factors in a cohort of copper–gold mining company workers in Papua, Indonesia. Methods Metabolic indicators of NCD risk were assessed among employees (15 580 at baseline, 6496 prospectively) of a large copper–gold mining operation in Papua, Indonesia, using routinely collected 5-year medical surveillance data. The study cohort comprised individuals aged 18–68 years employed for ≥1 year during 2008–2013. Assessed risk factors were based on repeat measures of cholesterol, blood glucose, blood pressure and body weight, using WHO criteria. Results Metabolic risk indicator rates were markedly high and increased significantly from baseline through 5-year follow-up (p<0.001). Adjusting for gender and age, longer duration of employment (≥10 years) predicted raised cholesterol (adjusted OR (AOR)=1.13, p=0.003), raised blood pressure (AOR=1.16, p=0.009) and overweight/obesity (AOR=1.14, p=0.001) at baseline; and persistent raised cholesterol (AOR=1.26, p=0.003), and both incident (AOR=1.33, p=0.014) and persistent raised blood glucose (AOR=1.62, p=0.044) at 3-year follow-up. Conclusions Individuals employed for longer periods in a mining operations setting in Papua, Indonesia, may face elevated NCD risk through various routes. Workplace health promotion interventions and policies targeting modifiable lifestyle patterns and environmental exposures present an important opportunity to reduce such susceptibilities and mitigate associated health risks. PMID:26231573

Non-communicable diseases and global health governance: enhancing global processes to improve health development

PubMed Central

Magnusson, Roger S

2007-01-01

This paper assesses progress in the development of a global framework for responding to non-communicable diseases, as reflected in the policies and initiatives of the World Health Organization (WHO), World Bank and the UN: the institutions most capable of shaping a coherent global policy. Responding to the global burden of chronic disease requires a strategic assessment of the global processes that are likely to be most effective in generating commitment to policy change at country level, and in influencing industry behaviour. WHO has adopted a legal process with tobacco (the WHO Framework Convention on Tobacco Control), but a non-legal, advocacy-based approach with diet and physical activity (the Global Strategy on Diet, Physical Activity and Health). The paper assesses the merits of the Millennium Development Goals (MDGs) and the FCTC as distinct global processes for advancing health development, before considering what lessons might be learned for enhancing the implementation of the Global Strategy on Diet. While global partnerships, economic incentives, and international legal instruments could each contribute to a more effective global response to chronic diseases, the paper makes a special case for the development of international legal standards in select areas of diet and nutrition, as a strategy for ensuring that the health of future generations does not become dependent on corporate charity and voluntary commitments. A broader frame of reference for lifestyle-related chronic diseases is needed: one that draws together WHO's work in tobacco, nutrition and physical activity, and that envisages selective use of international legal obligations, non-binding recommendations, advocacy and policy advice as tools of choice for promoting different elements of the strategy. PMID:17519005

Non-communicable diseases and global health governance: enhancing global processes to improve health development.

PubMed

Magnusson, Roger S

2007-05-22

This paper assesses progress in the development of a global framework for responding to non-communicable diseases, as reflected in the policies and initiatives of the World Health Organization (WHO), World Bank and the UN: the institutions most capable of shaping a coherent global policy. Responding to the global burden of chronic disease requires a strategic assessment of the global processes that are likely to be most effective in generating commitment to policy change at country level, and in influencing industry behaviour. WHO has adopted a legal process with tobacco (the WHO Framework Convention on Tobacco Control), but a non-legal, advocacy-based approach with diet and physical activity (the Global Strategy on Diet, Physical Activity and Health). The paper assesses the merits of the Millennium Development Goals (MDGs) and the FCTC as distinct global processes for advancing health development, before considering what lessons might be learned for enhancing the implementation of the Global Strategy on Diet. While global partnerships, economic incentives, and international legal instruments could each contribute to a more effective global response to chronic diseases, the paper makes a special case for the development of international legal standards in select areas of diet and nutrition, as a strategy for ensuring that the health of future generations does not become dependent on corporate charity and voluntary commitments. A broader frame of reference for lifestyle-related chronic diseases is needed: one that draws together WHO's work in tobacco, nutrition and physical activity, and that envisages selective use of international legal obligations, non-binding recommendations, advocacy and policy advice as tools of choice for promoting different elements of the strategy.

Lifestyle Choices Fuel Epidemics of Diabetes and Cardiovascular Disease Among Asian Indians.

PubMed

O'Keefe, Evan L; DiNicolantonio, James J; Patil, Harshal; Helzberg, John H; Lavie, Carl J

2016-01-01

Within the next 15years, India is projected to overtake China as the world's most populous nation. Due to the rapid pace of urbanization and modernization fueling population growth, in conjunction with a genetic predisposition to insulin resistance, India is suffering a rising epidemic of non-communicable diseases (NCDs), including coronary artery disease (CAD), type 2 diabetes mellitus (T2DM), and stroke. In addition to the genetic predisposition, major negative lifestyle factors are contributing to the alarming outbreak of cardiovascular disease (CVD) among the Asian Indian population; these factors include: 1) a diet high in added sugar, refined grains and other processed foods, 2) physical inactivity, 3) vitamin D deficiency (VDD), and 4) smoking/pollution. These risk factors are all highly modifiable, and steps to improve these issues should be taken urgently to avoid a worsening NCD crisis among the inhabitants of the South Asian subcontinent as well as for people with Asian Indian ethnicity worldwide. Copyright © 2015 Elsevier Inc. All rights reserved.

Risk Factors of Non-Communicable Diseases and Metabolic Syndrome

PubMed Central

Esmailnasab, N; Moradi, G; Delaveri, A

2012-01-01

Background Metabolic syndrome is a common nmetabolic ndisorder, which leads to early Cardio Vascular Disease and diabetes type II. The goal of this study was to determine the prevalence of metabolic syndrome and its risk factors in Kurdistan, Iran. Method: The data was extracted from provincial section of Iranian national non-communicable surveillance survey conducted in 2005. The study was a population-based survey with multi-stage cluster sampling method. Adult Treatment Panel-III measures were used for assessing the prevalence of metabolic syndrome among residents of Kurdistan Province aged 25 to 64 yr. EPI-Info 6 was used to enter the data and the data was analyzed using SPSS 11.5. Results: Totally, 1194 participants were recruited in our survey. The prevalence of metabolic syndrome was 29.1%. The prevalence was 41.3% among women and 17.1% among men (P= 0.001). As we go higher among age groups, the prevalence increases. Conclusion: This is the first study to investigate the metabolic syndrome in Kurdistan and Kurd ethnicity. The high level of metabolic syndromes prevalence especially among women shows the need and importance of suitable and effective preventive programs. These preventive programs must promote changes in lifestyle, especially with respect to nutrition, physical activities, and control of blood pressure. PMID:23113214

Catastrophic Health Expenditure of Chronic Diseases: Evidence from Hamadan, Iran

PubMed Central

Rezapour, Aziz; Vahedi, Sajad; Khiavi, Farzad Faraji; Esmaeilzadeh, Firooz; Javan-Noughabi, Javad; Rajabi, Abdolhalim

2017-01-01

Background: Chronic noncommunicable diseases (NCDs) could increase the risk of catastrophic health expenditure (CHE). The present study aims to analyze CHE among households with and without chronic NCDs in Hamedan. Methods: In this cross-sectional study, 780 households’ patients, who were being discharged from hospitals in Hamedan, were selected using a proportional stratified random sampling method. Required data were collected through interview and observation using World Health Organization standard questionnaire. A household with chronic NCDs is defined as the one with ≥1 chronic disease patient. Both descriptive and analytical statistics, as well as different approaches and thresholds, were used to study CHE among households. Results: The households with chronic disease had higher incidence and intensity of CHE in all approaches and threshold. This result was shown through distributive-sensitive measures. The Regression analysis revealed that lower economic status, lower household size, and high utilization of health care were associated with the CHE incidence and intensity in the households with chronic NCDs in Hamedan. Conclusions: There is a high degree of CHE were caused by chronic NCDs. By thoughtful reconsideration in health-care financing, along with addressing relevant socioeconomic factors, the health system of Iran could cope with financial adversities caused by chronic NCDs. PMID:29291041

Baseline assessment of WHO’s target for both availability and affordability of essential medicines to treat non-communicable diseases

PubMed Central

Ewen, Margaret; Zweekhorst, Marjolein; Regeer, Barbara; Laing, Richard

2017-01-01

Background WHO has set a voluntary target of 80% availability of affordable essential medicines, including generics, to treat major non-communicable diseases (NCDs), in the public and private sectors of countries by 2025. We undertook a secondary analysis of data from 30 surveys in low- and middle-income countries, conducted from 2008–2015 using the World Health Organization (WHO)/Health Action International (HAI) medicine availability and price survey methodology, to establish a baseline for this target. Methods Data for 49 medicines (lowest priced generics and originator brands) to treat cardiovascular diseases (CVD), diabetes, chronic obstructive pulmonary diseases (COPD) and central nervous system (CNS) conditions were analysed to determine their availability in healthcare facilities and pharmacies, their affordability for those on low incomes (based on median patient prices of each medicine), and the percentage of medicines that were both available and affordable. Affordability was expressed as the number of days’ wages of the lowest-paid unskilled government worker needed to purchase 30 days’ supply using standard treatment regimens. Paying more than 1 days’ wages was considered unaffordable. Findings In low-income countries, 15.2% and 18.9% of lowest-priced generics met WHO’s target in the public and private sectors, respectively, and 2.6% and 5.2% of originator brands. In lower-middle income countries, 23.8% and 23.2% of lowest priced generics, and 0.8% and 1.4% of originator brands, met the target in the public and private sectors, respectively. In upper-middle income countries, the situation was better for generics but still suboptimal as 36.0% and 39.4% met the target in public and private sectors, respectively. For originator brands in upper-middle income countries, none reached the target in the public sector and 13.7% in the private sector. Across the therapeutic groups for lowest priced generics, CVD medicines in low-income countries (11

Population health and burden of disease profile of Iran among 20 countries in the region: from Afghanistan to Qatar and Lebanon.

PubMed

Shahraz, Saeid; Forouzanfar, Mohammad Hossein; Sepanlou, Sadaf G; Dicker, Daniel; Naghavi, Paria; Pourmalek, Farshad; Mokdad, Ali; Lozano, Rafael; Vos, Theo; Asadi-Lari, Mohsen; Sayyari, Ali-Akbar; Murray, Christopher J L; Naghavi, Mohsen

2014-05-01

Population health and disease profiles are diverse across Iran's neighboring countries. Borrowing the results of the country-level Global Burden of Diseases, Injuries, and Risk Factors 2010 Study (GBD 2010), we aim to compare Iran with 19 countries in terms of an important set of population health and disease metrics. These countries include those neighboring Iran and a few other countries from the Middle East and North Africa (MENA) region. We show the pattern of health transition across the comparator countries from 1990 through 2010. We use classic GBD metrics measured for the year 2010 to indicate the rank of Iran among these nations. The metrics include disability-adjusted life years (DALYs), years of life lost as a result of premature death (YLLs), years of life lost due to disability (YLDs), health-adjusted life expectancy (HALE), and age-standardized death rate (ASD). Considerable and uniform transition from communicable, maternal, neonatal, and nutritional (CMMN) conditions to non-communicable diseases (NCDs) was seen between 1990 and 2010. On average, ischemic heart disease, lower respiratory infections, and road injuries were the three principal causes of YLLs, while low back pain and major depressive disorders were the top causes of YLDs in these countries. Iran ranked 13th in HALE and 12th in ASD. The function of Iran's health care, measured by DALYs, was somewhat in the middle of the HALE spectrum for the comparator countries. This intermediate position becomes rather highlighted when Afghanistan, as outlier, is taken out of the comparison. Effective policies to reduce NCDs need to be formulated and implemented through an integrated health care system. Our comparison shows that Iran can learn from the experience of a number of these countries to devise and execute the required strategies.

Nutrient reference value: non-communicable disease endpoints--a conference report.

PubMed

Lupton, J R; Blumberg, J B; L'Abbe, M; LeDoux, M; Rice, H B; von Schacky, C; Yaktine, A; Griffiths, J C

2016-03-01

scientific evidence does exist to confirm a relationship between the intake of a specific bioactive constituent and enhanced health conditions or reduced risk of a chronic disease. Further, research on the putative mechanisms of action of various classes of bioactives is supported by national and pan-national government agencies, and academic institutions, as well as functional food and dietary supplement manufacturers. Consumers are becoming educated and are seeking to purchase products containing bioactives, yet there is no evaluative process in place to let the public know how strong the science is behind the benefits or the quantitative amounts needed to achieve these beneficial health effects or to avoid exceeding the upper level (UL). When one lacks an essential nutrient, overt deficiency with concomitant physiological determents and eventually death are expected. The absence of bioactive substances from the diet results in suboptimal health, e.g., poor cellular and/or physiological function, which is relative and not absolute. Regrettably at this time, there is no DRI process to evaluate bioactives, although a recent workshop convened by the National Institutes of Health (Options for Consideration of Chronic Disease Endpoints for Dietary Reference Intakes (DRIs); March 10-11, 2015; http://health.gov/dietaryguidelines/dri/ ) did explore the process to develop DVs for nutrients, the lack of which result in increased risk of chronic disease (non-communicable disease) endpoints. A final report is expected soon. This conference (CRN-International Scientific Symposium; "Nutrient Reference Value-Non-Communicable Disease (NRV-NCD) Endpoints," 20 November in Kronberg, Germany; http://www.crn-i.ch/2015symposium/ ) explores concepts related to the Codex NRV process, the public health opportunities in setting NRVs for bioactive constituents, and further research and details on the specific class of bioactives, n-3 long-chain polyunsaturated fatty acids (also termed omega-3 fatty

Developmental origins of non-communicable disease: Implications for research and public health

PubMed Central

2012-01-01

This White Paper highlights the developmental period as a plastic phase, which allows the organism to adapt to changes in the environment to maintain or improve reproductive capability in part through sustained health. Plasticity is more prominent prenatally and during early postnatal life, i.e., during the time of cell differentiation and specific tissue formation. These developmental periods are highly sensitive to environmental factors, such as nutrients, environmental chemicals, drugs, infections and other stressors. Nutrient and toxicant effects share many of the same characteristics and reflect two sides of the same coin. In both cases, alterations in physiological functions can be induced and may lead to the development of non-communicable conditions. Many of the major diseases – and dysfunctions – that have increased substantially in prevalence over the last 40 years seem to be related in part to developmental factors associated with either nutritional imbalance or exposures to environmental chemicals. The Developmental Origins of Health and Disease (DOHaD) concept provides significant insight into new strategies for research and disease prevention and is sufficiently robust and repeatable across species, including humans, to require a policy and public health response. This White Paper therefore concludes that, as early development (in utero and during the first years of postnatal life) is particularly sensitive to developmental disruption by nutritional factors or environmental chemical exposures, with potentially adverse consequences for health later in life, both research and disease prevention strategies should focus more on these vulnerable life stages. PMID:22715989

Non-electronic communication aids for people with complex communication needs.

PubMed

Iacono, Teresa; Lyon, Katie; West, Denise

2011-10-01

Non-electronic communication aids provide one form of augmentative and alternative communication (AAC) for people with complex communication needs. The aim here was to explore non-electronic communication aids as one AAC option and research challenges. This aim was addressed by reviewing funding for the provision of AAC systems, data from an Australian pilot project providing non-electronic communication aids, an audit of aided AAC published studies (2000-2009), and discussion of the review literature. Combined, these sources indicate that although there is great demand for non-electronic communication aids, funding schemes, both in Australia and internationally, have focused on electronic communication aids. Such funding has usually failed to meet the total device costs and has not provided for adequate speech-language pathology support. Data from the pilot indicated the demand for non-electronic communication aids, and patterns suggest potential factors that govern the types selected. Despite the high demand for non-electronic aids, the research literature has tended to focus on electronic communication aids, including within intervention studies and addressing design features and long-term outcomes. Concerns about ensuring that AAC systems are chosen according to the assessed needs of individuals are discussed within the context of limitations in outcomes research and appropriate outcome measures.

[Behavioral risk factors of chronic non-communicable diseases in medical doctors].

PubMed

Исаева, Анна С; Резник, Лариса А; Вовченко, Марина Н; Буряковская, Алена А; Довганюк, Инна Э

medical doctors. Absence of continuous sleep and early awakenings dominated between diagnosed sleep disorders. Fifty three percent of women and 47 percent of men had early awakenings. Conclusions: the main part of medical doctors in present study had low physical activity, sleep disorders and unhealthy nutrition behavior. So, special programs designed for medical professionals are needed to correct risk of chronic non-communicable disease related to behavioral factors.

Rural, Urban and Migrant Differences in Non-Communicable Disease Risk-Factors in Middle Income Countries: A Cross-Sectional Study of WHO-SAGE Data

PubMed Central

Oyebode, Oyinlola; Pape, Utz J.; Laverty, Anthony A.; Lee, John T.; Bhan, Nandita; Millett, Christopher

2015-01-01

Background Understanding how urbanisation and rural-urban migration influence risk-factors for non-communicable disease (NCD) is crucial for developing effective preventative strategies globally. This study compares NCD risk-factor prevalence in urban, rural and migrant populations in China, Ghana, India, Mexico, Russia and South Africa. Methods Study participants were 39,436 adults within the WHO Study on global AGEing and adult health (SAGE), surveyed 2007–2010. Risk ratios (RR) for each risk-factor were calculated using logistic regression in country-specific and all country pooled analyses, adjusted for age, sex and survey design. Fully adjusted models included income quintile, marital status and education. Results Regular alcohol consumption was lower in migrant and urban groups than in rural groups (pooled RR and 95%CI: 0.47 (0.31–0.68); 0.58, (0.46–0.72), respectively). Occupational physical activity was lower (0.86 (0.72–0.98); 0.76 (0.65–0.85)) while active travel and recreational physical activity were higher (pooled RRs for urban groups; 1.05 (1.00–1.09), 2.36 (1.95–2.83), respectively; for migrant groups: 1.07 (1.0 -1.12), 1.71 (1.11–2.53), respectively). Overweight, raised waist circumference and diagnosed diabetes were higher in urban groups (1.19 (1.04–1.35), 1.24 (1.07–1.42), 1.69 (1.15–2.47), respectively). Exceptions to these trends exist: obesity indicators were higher in rural Russia; active travel was lower in urban groups in Ghana and India; and in South Africa, urban groups had the highest alcohol consumption. Conclusion Migrants and urban dwellers had similar NCD risk-factor profiles. These were not consistently worse than those seen in rural dwellers. The variable impact of urbanisation on NCD risk must be considered in the design and evaluation of strategies to reduce the growing burden of NCDs globally. PMID:25849356

Prevalence of non-communicable diseases in Brazilian children: follow-up at school age of two Brazilian birth cohorts of the 1990's

PubMed Central

2011-01-01

Background Few cohort studies have been conducted in low and middle-income countries to investigate non-communicable diseases among school-aged children. This article aims to describe the methodology of two birth cohorts, started in 1994 in Ribeirão Preto (RP), a more developed city, and in 1997/98 in São Luís (SL), a less developed town. Methods Prevalences of some non-communicable diseases during the first follow-up of these cohorts were estimated and compared. Data on singleton live births were obtained at birth (2858 in RP and 2443 in SL). The follow-up at school age was conducted in RP in 2004/05, when the children were 9-11 years old and in SL in 2005/06, when the children were 7-9 years old. Follow-up rates were 68.7% in RP (790 included) and 72.7% in SL (673 participants). The groups of low (<2500 g) and high (≥ 4250 g) birthweight were oversampled and estimates were corrected by weighting. Results In the more developed city there was a higher percentage of non-nutritive sucking habits (69.1% vs 47.9%), lifetime bottle use (89.6% vs 68.3%), higher prevalence of primary headache in the last 15 days (27.9% vs 13.0%), higher positive skin tests for allergens (44.3% vs 25.3%) and higher prevalence of overweight (18.2% vs 3.6%), obesity (9.5% vs 1.8%) and hypertension (10.9% vs 4.6%). In the less developed city there was a larger percentage of children with below average cognitive function (28.9% vs 12.2%), mental health problems (47.4% vs 38.4%), depression (21.6% vs 6.0%) and underweight (5.8% vs 3.6%). There was no difference in the prevalence of bruxism, recurrent abdominal pain, asthma and bronchial hyperresponsiveness between cities. Conclusions Some non-communicable diseases were highly prevalent, especially in the more developed city. Some high rates suggest that the burden of non-communicable diseases will be high in the future, especially mental health problems. PMID:21693042

[Prevalence of Risk Factors of Non-Communicable Disease in Kyrgyzstan: Assessment using WHO STEPS Approach].

PubMed

A, T A; Makhmutkhodzhaev, S A; Kydyralieva, R B; Altymysheva, A T; Dzhakipova, R S; Zhorupbekova, K S; Ryskulova, S T; Knyazeva, V G; Kaliev, M T; Dzhumagulova, A S

2016-12-01

Assessment of prevalence of risk factors for non-communicable diseases (NCD) based on WHO "STEPS" approach was conducted in Kyrgyzstan. Results of this study demonstrated high prevalence of NCD risk factors: 94.2% of subjects aged 24-64 years had risk factors. Prevalence of elevated blood pressure was 48.7, smoking - 25.7, hypercholesterolemia - 23.6, excessive alcohol consumption - 31.4, physical inactivity 11.4, obesity - 23.1, elevated glucose level - 4.5, diabetes - 8.8, inadequate intake of fruits and vegetables - 74%. The data obtained would allow to draft effective preventive measures to combat NCD risk factors at the national level.

[Health policy interventions: the pathway to public health].

PubMed

Andersen, Karl; Gudnason, Vilmundur

2013-03-01

Chronic non-communicable diseases (NCDs) are currently the main cause of premature death and disability in the world. Most of these NCDs are due to unhealthy lifestyle choices i.e. tobacco, unhealthy diet, lack of physical exercise and alcohol consumption. Studies have shown that health policy interventions aiming at improving diet and physical activity and reducing tobacco consumption are inexpensive, effective and cost saving. In this paper we address the political health policy interventions that have been shown to improve public health. We discuss some of the theories of behavioral economics which explain the processes involved in our every-day choices regarding lifestyle and diet.

European Non-Communicable Respiratory Disease Research, 2002-13: Bibliometric Study of Outputs and Funding

PubMed Central

Wright, John S. F.; Pallari, Elena; Sullivan, Richard

2016-01-01

This study was conducted in order to map European research in chronic respiratory diseases (CRDs). It was intended to assist the European Commission and other research funders to identify gaps and overlaps in their portfolios, and to suggest ways in which they could improve the effectiveness of their support and increase the impact of the research on patient care and on the reduction of the incidence of the CRDs. Articles and reviews were identified in the Web of Science on research in six non-communicable respiratory diseases that were published in 2002–13 from 31 European countries. They represented only 0.8% of biomedical research output but these diseases accounted for 4.7% of the European disease burden, as measured by Disability-Adjusted Life Years (DALYs), so the sub-field is seriously under-researched. Europe is prominent in the sub-field and published 56% of the world total, with the UK the most productive and publishing more than France and Italy, the next two countries, combined. Asthma and Chronic Obstructive Pulmonary Disease (COPD) were the diseases with the most publications and the highest citation rates. They also received the most funding, with around two acknowledgments per paper (in 2009–13), whereas cystic fibrosis and emphysema averaged only one. Just over 37% of papers had no specific funding and depended on institutional support from universities and hospitals. PMID:27111670

Cardiovascular health in the Americas: facts, priorities and the UN high-level meeting on non-communicable diseases.

PubMed

Ordúñez, Pedro

2011-10-01

Population aging, smoking, unhealthy diet and physical inactivity, in the context of globalization and unregulated urbanization, explain the high prevalences of hypertension, hypercholesterolemia and diabetes in the Americas, making cardiovascular diseases the main cause of death. Moreover, cardiovascular diseases and their risk factors disproportionately affect the poorest people, obstructing antipoverty efforts and further deepening health and other inequities. The global crisis of chronic non-communicable diseases has reached such proportions that the UN General Assembly called a high-level meeting in September 2011 to address the issue as one of human development, aiming to stimulate political commitment to a concerted global effort to stem the pandemic. In reference to the Americas, this article reviews the burden of cardiovascular diseases and describes priorities for strategies and action in the region and their relation to the results of the UN meeting.

An exploratory study on risk factors for chronic non-communicable diseases among adolescents in Malaysia: overview of the Malaysian Health and Adolescents Longitudinal Research Team study (The MyHeART study).

PubMed

Hazreen, Majid Abdul; Su, Tin Tin; Jalaludin, Muhammad Yazid; Dahlui, Maznah; Chinna, Karuthan; Ismail, Maslinor; Murray, Liam; Cantwell, Marie; Al Sadat, Nabilla

2014-01-01

The National Health & Morbidity Survey (NHMS) IV (2011) observed that the prevalence of obese children aged less than 18 years in Malaysia is 6.1% compared to 5.4% overweight and obese in NHMS III (2006). As such, this observation is of public health importance as obesity is a forewarning risk factor for chronic diseases such as type-2 diabetes, cardiovascular diseases (CVD) and certain types of cancers. This MyHeART (Malaysian Health and Adolescents longitudinal Research Team) study aims to examine risk factors of non-communicable diseases (NCD) among adolescents. The MyHeART study is longitudinal cohort study of 1361 schoolchildren (13-years old) attending 15 public secondary schools from the central (Kuala Lumpur and Selangor) and northern (Perak) regions of Peninsular Malaysia. The study used a stratified sampling design to select the study participants. Data collected at baseline included socio-economic, lifestyle (e.g. smoking, physical activity assessment, fitness assessment, seven-day diet history), and environmental information, anthropometric measurements, blood pressure, handgrip strength and bone mineral density. Blood samples for fasting blood glucose and lipid profiles, full blood count, renal profile, as well as bone profile and serum vitamin D were taken. This study cohort will be followed up again when participants turn 15, 17 and lastly, after a period of ten years (around the age of 27). Nine percent of the adolescents from this study were obese. More male participants smoked compared to female participants (15.4% vs. 4.7%). Adolescent males had higher fasting blood glucose but the female participants had lower high density lipoprotein (HDL-cholesterol) and higher low density lipoprotein (LDL-cholesterol). In addition, adolescents from the rural area had higher fasting blood glucose, diastolic blood pressure, total cholesterol and LDL-cholesterol. Our results demonstrated that adolescents from the rural area are at higher risk of NCDs compared to

Men's health: non-communicable chronic diseases and social vulnerability.

PubMed

Bidinotto, Daniele Natália Pacharone Bertolini; Simonetti, Janete Pessuto; Bocchi, Silvia Cristina Mangini

2016-08-15

to evaluate the relationship between absences in scheduled appointments and the number of non-communicable chronic diseases and to investigate the relationship between spatial distribution of these diseases and social vulnerability, using geoprocessing. a quantitative study of sequential mixed approach by analyzing 158 medical records of male users to relate the absences and 1250 medical records for geoprocessing. the higher the number of absences in the scheduled medical appointments, the less were the number of non-communicable chronic diseases and the ones listed in the International Classification of Diseases in single men. There were 21 significant geostatistically cases of glucose intolerance in the urban area. Of these, 62% lived in a region with a social vulnerability rating of Very Low, Medium 19%, 14% Low and 5% High. it was observed that the older the men, the greater is the number of chronic diseases and the less they miss scheduled appointments. Regarding the use of geoprocessing, we obtained a significant number of cases of glucose intolerance in urban areas, the majority classified as Very Low social vulnerability. It was possible to relate the spatial distribution of these diseases with the social vulnerability classification; however, it was not possible to perceive a relationship of them with the higher rates of social vulnerability. avaliar a relação entre as faltas em consultas agendadas e o número de doenças crônicas não transmissíveis e averiguar a relação entre distribuição espacial dessas doenças e vulnerabilidade social, utilizando-se o geoprocessamento. estudo quantitativo, de abordagem mista sequencial, sendo analisados 158 prontuários de usuários do sexo masculino para se relacionar as faltas e 1250 prontuários para o geoprocessamento. quanto maior o número de faltas nas consultas médicas agendadas, menores foram a quantidade de doenças crônicas não transmissíveis e as listadas na Classificação Internacional de

[Risk factors for non communicable chronic diseases among workers of a financial company].

PubMed

Fagalde, María del Pilar; del Solar, José Antonio; Guerrero, Marcia; Atalah, Eduardo

2005-08-01

The epidemic of cardiovascular diseases in Chile, requires the development of strategies in health promotion and prevention. To assess the prevalence of risk factors for chronic non communicable diseases among workers of a financial company in Metropolitan Santiago. Assessment of 2,225 workers (1,383 males with a median age of 49 years and 842 females with a median age of 43 years). All answered an enquiry about education, medical history, smoking habits and physical activity. Body mass index and blood pressure were measured and a blood sample was obtained to measure blood glucose and lipid levels. Logistic repression models were used to determine the main risk factors for hypertension, diabetes, obesity, hypercholesterolemia and hyperuricemia. Sixteen percent of studied subjects were obese, 49% had overweight, 57% had hypercholesterolemia, 28% had high blood pressure, 4% were diabetic, 4% had hyperuricemia, 45% smoked and 83% were sedentary. Each worker had a mean of 2.4+/-1.1 risk factors. This figure was significantly higher among men, obese subjects, those older than 40 years and those with a lower educational level. There is an important disease burden among the studied subjects, specially among obese and older individuals. Healthy lifestyles should be promoted in this population.

Strengthening the Health System to Better Confront Noncommunicable Diseases in India

PubMed Central

Duran, Antonio; Khot, Anagha

2011-01-01

The paper emphasizes the vital need to address the rising burden of noncommunicable diseases (NCDs) in India with a health systems approach. The authors argue that adoption of such approach may soon be imperative. Applying the health systems framework developed by the WHO in 2000 to NCDs means in summary re-examining the planning and organization of the entire health system, from service provision to financing, from information generation to ensuring adequate supply of pharmaceuticals/technologies or human resources, from improving facility management to performance monitoring. Using this framework the authors seek to highlight core issues and identify possible policy actions required. The challenge is to ensure the best implementation of what works, aligning the service provision function with the financial incentives, ensuring leadership/stewardship by the government across local/municipal, state or regional and national level while involving stakeholders. A health system perspective would also ensure that action against NCD goes hand in hand with tackling the remaining burden from communicable diseases, maternal, child health and nutrition issues. PMID:22628908

Nations within a nation: variations in epidemiological transition across the states of India, 1990-2016 in the Global Burden of Disease Study.

PubMed

2017-12-02

18% of the world's population lives in India, and many states of India have populations similar to those of large countries. Action to effectively improve population health in India requires availability of reliable and comprehensive state-level estimates of disease burden and risk factors over time. Such comprehensive estimates have not been available so far for all major diseases and risk factors. Thus, we aimed to estimate the disease burden and risk factors in every state of India as part of the Global Burden of Disease (GBD) Study 2016. Using all available data sources, the India State-Level Disease Burden Initiative estimated burden (metrics were deaths, disability-adjusted life-years [DALYs], prevalence, incidence, and life expectancy) from 333 disease conditions and injuries and 84 risk factors for each state of India from 1990 to 2016 as part of GBD 2016. We divided the states of India into four epidemiological transition level (ETL) groups on the basis of the ratio of DALYs from communicable, maternal, neonatal, and nutritional diseases (CMNNDs) to those from non-communicable diseases (NCDs) and injuries combined in 2016. We assessed variations in the burden of diseases and risk factors between ETL state groups and between states to inform a more specific health-system response in the states and for India as a whole. DALYs due to NCDs and injuries exceeded those due to CMNNDs in 2003 for India, but this transition had a range of 24 years for the four ETL state groups. The age-standardised DALY rate dropped by 36·2% in India from 1990 to 2016. The numbers of DALYs and DALY rates dropped substantially for most CMNNDs between 1990 and 2016 across all ETL groups, but rates of reduction for CMNNDs were slowest in the low ETL state group. By contrast, numbers of DALYs increased substantially for NCDs in all ETL state groups, and increased significantly for injuries in all ETL state groups except the highest. The all-age prevalence of most leading NCDs

Health promotion services for patients having non-comminicable diseases: Feedback from patients and health care providers in Cape Town, South Africa

PubMed Central

2012-01-01

Background Due to a paucity of data regarding the availability and efficacy of equipment, health promotion methods and materials currently used by health professionals for the management of patients with non-communicable diseases (NCDs) at primary health care (PHC) facilities in Cape Town, an audit was undertaken. Methods A multi-centre cross-sectional study was undertaken to interview patients (n = 580) with NCDs at 30 PHC facilities. A questionnaire was used to obtain information on preferences for health promotion methods for lifestyle modification. Individual semi-structured interviews were conducted with selected health professionals (n = 14) and captured using a digital recorder. Data were transferred to the Atlas ti software programme and analysed using a thematic content analysis approach. Results Blood pressure measurement (97.6%) was the most common diagnostic test used, followed by weight measurement (88.3%), urine (85.7%) and blood glucose testing (80.9%). Individual lifestyle modification counselling was the preferred health education method of choice for the majority of patients. Of the 64% of patients that selected chronic clubs/support groups as a method of choice, only a third rated this as their first choice. Pamphlets, posters and workshops/group counselling sessions were the least preferred methods with only 9%, 13% and 11% of patients choosing these as their first choice, respectively. In an individual counselling setting 44.7% of patients reported that they would prefer to be counselled by a doctor, followed by a nurse (16.9%), health educator (8.8%) and nutrition advisor (4.8%). Health professionals identified numerous barriers to education and counselling. These can be summarised as a lack of resources, including time, space and equipment; staff-related barriers such as staff shortage and staff turnover; and patient-related barriers such as patient load and patient non-compliance. Conclusion The majority of patients attending PHC

Premature Mortality from Cardiovascular Disease in the Americas - Will the Goal of a Decline of "25% by 2025" be Met?

PubMed

Ordunez, Pedro; Prieto-Lara, Elisa; Pinheiro Gawryszewski, Vilma; Hennis, Anselm J M; Cooper, Richard S

2015-01-01

Cardiovascular diseases (CVD) are the underlying cause 1.6 million deaths per year in the Americas, accounting for 30% of total mortality and 38% of by non-communicable deaths diseases (NCDs). A 25% reduction in premature mortality due four main NCDs was targeted by the 2011 High-level Meeting of the General Assembly on the Prevention and Control of NCDs. While overall CVD mortality fell in the Americas during the past decade, trends in premature CVD mortality during the same period have not been described, particularly in the countries of Latin America and the Caribbean. This is a population-based trend-series study based on a total of 6,133,666 deaths to describe the trends and characteristics of premature mortality due to CVD and to estimates of the average annual percentage of change during the period 2000-2010 in the Americas. Premature mortality due to CVD in the Americas fell by 21% in the period 2000-2010 with a -2.5% average annual rate of change in the last 5 year-a statistically significant reduction of mortality-. Mortality from ischemic diseases, declined by 25% - 24% among men and 26% among women. Cerebrovascular diseases declined by 27% -26% among men and 28% among women. Guyana, Trinidad and Tobago, the Dominican Republic, Bahamas, and Brazil had CVD premature mortality rates over 200 per 100,000 population, while the average for the Region was 132.7. US and Canada will meet the 25% reduction target before 2025. Mexico, Costa Rica, Venezuela, Dominican Republic, Panama, Guyana, and El Salvador did not significantly reduce premature mortality among men and Guyana, the Dominican Republic, and Panama did not achieve the required annual reduction in women. Trends in premature mortality due to CVD observed in last decade in the Americas would indicate that if these trends continue, the Region as a whole and a majority of its countries will be able to reach the goal of a 25% relative reduction in premature mortality even before 2025.

Aspects of communication in Alzheimer's disease: clinical features and treatment options.

PubMed

Woodward, Michael

2013-06-01

During the course of Alzheimer's disease (AD), cognitive processes, including language and communication, become increasingly impaired. The aim of this review was to highlight the impact of communication deficits in AD, and discuss the need for effective treatments. PubMed was searched for studies relating to language and communication in AD. The publications identified were used as a basis for the commentary in this paper. Studies relating to the clinical effectiveness of pharmacological treatment for language and communication issues were identified systematically. Communication deficits are common in AD. From the earliest disease stage, the patient's capacity for communication declines as problems develop with the use of language and all aspects of functional communication. There is a loss of the ability to communicate thoughts and needs, and it becomes increasingly difficult to interact socially and sustain personal relationships with caregivers, family, and friends. It is unsurprising that patients become frustrated at their loss of self-expression, and studies have demonstrated that impaired communication is strongly linked with the development of significant behavioral concerns. Overall, poor communication contributes to caregiver strain, and adds notably to the burden of disease. Clinical data and post-hoc analyses provide preliminary indications that anti-AD therapies (memantine and the cholinesterase inhibitors, ChEIs) and non-pharmacological cognitive-linguistic stimulation techniques may be helpful in addressing communication difficulties. The capacity to treat or slow the progression of communication deficits in AD would prolong patient independence, and have a profound impact on the quality of life of patients and caregivers. The use of pharmacological (anti-AD therapies) and non-pharmacological (cognitive-linguistic stimulation) treatments may be useful management methods and warrant further investigation.

Translating the WHO 25×25 goals into a UK context: the PROMISE modelling study

PubMed Central

Cobiac, Linda J; Scarborough, Peter

2017-01-01

Objective Model the impact of targets for obesity, diabetes, raised blood pressure, tobacco use, salt intake, physical inactivity and harmful alcohol use, as outlined in the Global Non-Communicable Disease Action Plan 2013–2020, on mortality and morbidity in the UK population. Design Dynamic population modelling study. Setting UK population. Participants Not available. Main outcome measures Mortality and morbidity (years lived with disability) from non-communicable diseases (NCDs) that are averted or delayed. Probability of achieving a 25% reduction in premature mortality from NCDs by 2025 (current WHO target) and a 33% reduction by 2030 (proposed target). Results The largest improvements in mortality would be achieved by meeting the obesity target and the largest improvements in morbidity would be achieved by meeting the diabetes target. The UK could achieve the 2025 and 2030 targets for reducing premature mortality with only a little additional preventive effort compared with current practice. Achieving all 7 risk targets could avert a total of 300 000 deaths (95% uncertainty interval 250 000 to 350 000) and 1.3 million years lived with disability (1.2–1.4 million) from NCDs by 2025, with the majority of health gains due to reduced mortality and morbidity from heart disease and stroke, and reduced morbidity from diabetes. Potential reductions in morbidity from depression and in morbidity and mortality from dementia at older ages are also substantial. Conclusions The global premature mortality targets are a potentially achievable goal for countries such as the UK that can capitalise on many decades of effort in prevention and treatment. High morbidity diseases and diseases in later life are not addressed in the Global NCD Action Plan and targets, but must also be considered a priority for prevention in the UK where the population is ageing and the costs of health and social care are rising. PMID:28377390

Implementation of Policies and Strategies for Control of Noncommunicable Diseases in Malawi: Challenges and Opportunities

ERIC Educational Resources Information Center

Lupafya, Phindile Chitsulo; Mwagomba, Beatrice L. Matanje; Hosig, Kathy; Maseko, Lucy M.; Chimbali, Henry

2016-01-01

Malawi is a Sub-Saharan African country experiencing the epidemiological transition from predominantly infectious to noncommunicable diseases (NCDs) with dramatically increasing prevalence of lifestyle-related diseases such as obesity, hypertension, and diabetes. Malawi's 2011-2016 Health Sector Strategic Plan included NCDs, and an NCD Control…

Capacity of Commune Health Stations in Chi Linh District, Hai Duong Province, for Prevention and Control of Noncommunicable Diseases.

PubMed

Thi Thuy Nga, Nguyen; Thi My Anh, Bui; Nguyen Ngoc, Nguyen; Minh Diem, Dang; Duy Kien, Vu; Bich Phuong, Tran; Quynh Anh, Tran; Van Minh, Hoang

2017-07-01

The primary health care system in Vietnam has been playing an important role in prevention and control of diseases. This study aimed to describe the capacity of commune health stations in Chi Linh district, Hai Duong province for prevention and control of noncommunicable diseases (NCDs). A mixed-methods (quantitative and qualitative approaches) approach was applied to collect data in 20 commune health stations. The participants, including health workers, stakeholders, and patients with NCDs, were selected for the study. The findings reported that the main activities of prevention and control of NCDs at commune health stations (CHSs) still focused on information-education-community (IECs), unqualified for providing screening, diagnosis, and treatments of NCDs. The capacity for prevention and control of NCDs in CHSs was inadequate to provide health care services related to prevention and control of NCDs and unmet with the community's demands. In order to ensure the role and implementation of primary care level, there is an urgent need to improve the capacity of CHSs for prevention and control of NCDs, particularly a national budget for NCDs prevention and control, the essential equipment and medicines recommended by the World Health Organization should be provided and available at the CHSs.

Non-communicable disease risk factor patterns among mining industry workers in Papua, Indonesia: longitudinal findings from the Cardiovascular Outcomes in a Papuan Population and Estimation of Risk (COPPER) Study.

PubMed

Rodriguez-Fernandez, Rodrigo; Rahajeng, Ekowati; Viliani, Francesca; Kushadiwijaya, Haripurnomo; Amiya, Rachel M; Bangs, Michael J

2015-10-01

Non-communicable diseases (NCDs) constitute an increasing slice of the global burden of disease, with the South-East Asia region projected to see the highest increase in NCD-related deaths over the next decade. Mining industry employees may be exposed to various factors potentially elevating their NCD risk. This study aimed to assess the distribution and 5-year longitudinal trends of key metabolic NCD risk factors in a cohort of copper-gold mining company workers in Papua, Indonesia. Metabolic indicators of NCD risk were assessed among employees (15 580 at baseline, 6496 prospectively) of a large copper-gold mining operation in Papua, Indonesia, using routinely collected 5-year medical surveillance data. The study cohort comprised individuals aged 18-68 years employed for ≥1 year during 2008-2013. Assessed risk factors were based on repeat measures of cholesterol, blood glucose, blood pressure and body weight, using WHO criteria. Metabolic risk indicator rates were markedly high and increased significantly from baseline through 5-year follow-up (p<0.001). Adjusting for gender and age, longer duration of employment (≥10 years) predicted raised cholesterol (adjusted OR (AOR)=1.13, p=0.003), raised blood pressure (AOR=1.16, p=0.009) and overweight/obesity (AOR=1.14, p=0.001) at baseline; and persistent raised cholesterol (AOR=1.26, p=0.003), and both incident (AOR=1.33, p=0.014) and persistent raised blood glucose (AOR=1.62, p=0.044) at 3-year follow-up. Individuals employed for longer periods in a mining operations setting in Papua, Indonesia, may face elevated NCD risk through various routes. Workplace health promotion interventions and policies targeting modifiable lifestyle patterns and environmental exposures present an important opportunity to reduce such susceptibilities and mitigate associated health risks. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Oral Health Care in the Future: Expansion of the Scope of Dental Practice to Improve Health.

PubMed

Lamster, Ira B; Myers-Wright, Noreen

2017-09-01

The health care environment in the U.S. is changing. The population is aging, the prevalence of non-communicable diseases (NCDs) is increasing, edentulism is decreasing, and periodontal infection/inflammation has been identified as a risk factor for NCDs. These trends offer an opportunity for oral health care providers to broaden the scope of traditional dental practice, specifically becoming more involved in the management of the general health of patients. This new practice paradigm will promote a closer integration with the larger health care system. This change is based on the realization that a healthy mouth is essential for a healthy life, including proper mastication, communication, esthetics, and comfort. Two types of primary care are proposed: screenings for medical conditions that are directly affected by oral disease (and may modify the provision of dental care), and a broader emphasis on prevention that focuses on lifestyle behaviors. Included in the former category are screenings for NCDs (e.g., the risk of cardiovascular disease and identification of patients with undiagnosed dysglycemia or poorly managed diabetes mellitus), as well as identification of infectious diseases, such as HIV or hepatitis C. Reducing the risk of disease can be accomplished by an emphasis on smoking cessation and dietary intake and the prevention of obesity. These activities will promote interprofessional health care education and practice. While change is always challenging, this new practice paradigm could improve both oral health and health outcomes of patients seen in the dental office. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

Premature Mortality from Cardiovascular Disease in the Americas – Will the Goal of a Decline of “25% by 2025” be Met?

PubMed Central

Ordunez, Pedro; Prieto-Lara, Elisa; Pinheiro Gawryszewski, Vilma; Hennis, Anselm J. M.; Cooper, Richard S.

2015-01-01

Background Cardiovascular diseases (CVD) are the underlying cause 1.6 million deaths per year in the Americas, accounting for 30% of total mortality and 38% of by non-communicable deaths diseases (NCDs). A 25% reduction in premature mortality due four main NCDs was targeted by the 2011 High-level Meeting of the General Assembly on the Prevention and Control of NCDs. While overall CVD mortality fell in the Americas during the past decade, trends in premature CVD mortality during the same period have not been described, particularly in the countries of Latin America and the Caribbean. Methods This is a population-based trend-series study based on a total of 6,133,666 deaths to describe the trends and characteristics of premature mortality due to CVD and to estimates of the average annual percentage of change during the period 2000–2010 in the Americas. Findings Premature mortality due to CVD in the Americas fell by 21% in the period 2000–2010 with a -2.5% average annual rate of change in the last 5 year—a statistically significant reduction of mortality—. Mortality from ischemic diseases, declined by 25% - 24% among men and 26% among women. Cerebrovascular diseases declined by 27% -26% among men and 28% among women. Guyana, Trinidad and Tobago, the Dominican Republic, Bahamas, and Brazil had CVD premature mortality rates over 200 per 100,000 population, while the average for the Region was 132.7. US and Canada will meet the 25% reduction target before 2025. Mexico, Costa Rica, Venezuela, Dominican Republic, Panama, Guyana, and El Salvador did not significantly reduce premature mortality among men and Guyana, the Dominican Republic, and Panama did not achieve the required annual reduction in women. Conclusions Trends in premature mortality due to CVD observed in last decade in the Americas would indicate that if these trends continue, the Region as a whole and a majority of its countries will be able to reach the goal of a 25% relative reduction in premature

Nature Cure and Non-Communicable Diseases: Ecological Therapy as Health Care in India.

PubMed

Alter, Joseph S; Nair, R M; Nair, Rukmani

2017-12-07

With rapidly increasing rates of non-communicable diseases, India is experiencing a dramatic public health crisis that is closely linked to changing lifestyles and the growth of the middle-class. In this essay we discuss how the practice of Nature Cure provides a way of understanding the scale and scope of the crisis, as it is embodied, and a way to understand key elements of a solution to problems that the crisis presents for institutionalized health care. As institutionalized in contemporary India, Nature Cure involves treatment and managed care using earth, air, sunlight, and water as well as a strict dietary regimen. In this regard, the essay shows how Nature Cure's bio-ecological orientation toward public health, which is grounded in the history of its modern incorporation into India, provides an expansionist, ecological model for holistic care that counters the reductionist logic of bio-medical pharmaceuticalization.

Nature Cure and Non-Communicable Diseases: Ecological Therapy as Health Care in India

PubMed Central

Alter, Joseph S.; Nair, R. M.; Nair, Rukmani

2017-01-01

With rapidly increasing rates of non-communicable diseases, India is experiencing a dramatic public health crisis that is closely linked to changing lifestyles and the growth of the middle-class. In this essay we discuss how the practice of Nature Cure provides a way of understanding the scale and scope of the crisis, as it is embodied, and a way to understand key elements of a solution to problems that the crisis presents for institutionalized health care. As institutionalized in contemporary India, Nature Cure involves treatment and managed care using earth, air, sunlight, and water as well as a strict dietary regimen. In this regard, the essay shows how Nature Cure’s bio-ecological orientation toward public health, which is grounded in the history of its modern incorporation into India, provides an expansionist, ecological model for holistic care that counters the reductionist logic of bio-medical pharmaceuticalization. PMID:29215549

Women's health: a new global agenda

PubMed Central

Peters, Sanne A E; Woodward, Mark; Jha, Vivekanand; Kennedy, Stephen; Norton, Robyn

2016-01-01

Global efforts to improve the health of women largely focus on improving sexual and reproductive health. However, the global burden of disease has changed significantly over the past decades. Currently, the greatest burden of death and disability among women is attributable to non-communicable diseases (NCDs), most notably cardiovascular diseases, cancers, respiratory diseases, diabetes, dementia, depression and musculoskeletal disorders. Hence, to improve the health of women most efficiently, adequate resources need to be allocated to the prevention, management and treatment of NCDs in women. Such an approach could reduce the burden of NCDs among women and also has the potential to improve women's sexual and reproductive health, which commonly shares similar behavioural, biological, social and cultural risk factors. Historically, most medical research was conducted in men and the findings from such studies were assumed to be equally applicable to women. Sex differences and gender disparities in health and disease have therefore long been unknown and/or ignored. Since the number of women in studies is increasing, evidence for clinically meaningful differences between men and women across all areas of health and disease has emerged. Systematic evaluation of such differences between men and women could improve the understanding of diseases, as well as inform health practitioners and policymakers in optimising preventive strategies to reduce the global burden of disease more efficiently in women and men. PMID:28588958

Stigma-related experiences in non-communicable respiratory diseases: A systematic review.

PubMed

Rose, Shiho; Paul, Christine; Boyes, Allison; Kelly, Brian; Roach, Della

2017-08-01

The stigma of non-communicable respiratory diseases (NCRDs), whether perceived or otherwise, can be an important element of a patient's experience of his/her illness and a contributing factor to poor psychosocial, treatment and clinical outcomes. This systematic review examines the evidence regarding the associations between stigma-related experiences and patient outcomes, comparing findings across a range of common NCRDs. Electronic databases and manual searches were conducted to identify original quantitative research published to December 2015. Articles focussing on adult patient samples diagnosed with asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, lung cancer or mesothelioma, and included a measurement of stigma-related experience (i.e. perceived stigma, shame, blame or guilt), were eligible for inclusion. Included articles were described for study characteristics, outcome scores, correlates between stigma-related experiences and patient outcomes and methodological rigor. Twenty-five articles were eligible for this review, with most ( n = 20) related to lung cancer. No articles for cystic fibrosis were identified. Twenty unique scales were used, with low to moderate stigma-related experiences reported overall. The stigma-related experiences significantly correlated with all six patient-related domains explored (psychosocial, quality of life, behavioral, physical, treatment and work), which were investigated more widely in COPD and lung cancer samples. No studies adequately met all criteria for methodological rigor. The inter-connectedness of stigma-related experiences to other aspects of patient experiences highlight that an integrated approach is needed to address this important issue. Future studies should adopt more rigorous methodology, including streamlining measures, to provide robust evidence.

Early life nutritional programming of health and disease in The Gambia.

PubMed

Moore, S E

2016-04-01

Exposures during the early life (periconceptional, prenatal and early postnatal) period are increasingly recognized as playing an important role in the aetiology of chronic non-communicable diseases (NCD), including coronary heart disease, stroke, hypertension, Type 2 diabetes and osteoporosis. The 'Developmental Origins of Health and Disease' (DOHaD) hypothesis states that these disorders originate through unbalanced nutrition early in life and risk is highest when there is a 'mismatch' between the early- and later-life environments. Thus, the DOHaD hypothesis would predict highest risk in countries where an excess of infants are born with low birth weight and where there is a rapid transition to nutritional adequacy or excess in adulthood. Here, I will review data from work conducted in rural Gambia, West Africa. Using demographic data dating back to the 1940s, the follow-up of randomized controlled trials of nutritional supplementation in pregnancy and the 'experiment of nature' that seasonality in this region provides, we have investigated the DOHaD hypothesis in a population with high rates of maternal and infant under-nutrition, a high burden from infectious disease, and an emerging risk of NCDs.

Chronic Noncommunicable Diseases in 6 Low- and Middle-Income Countries: Findings From Wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (SAGE).

PubMed

Arokiasamy, Perianayagam; Uttamacharya; Kowal, Paul; Capistrant, Benjamin D; Gildner, Theresa E; Thiele, Elizabeth; Biritwum, Richard B; Yawson, Alfred E; Mensah, George; Maximova, Tamara; Wu, Fan; Guo, Yanfei; Zheng, Yang; Kalula, Sebastiana Zimba; Salinas Rodríguez, Aarón; Manrique Espinoza, Betty; Liebert, Melissa A; Eick, Geeta; Sterner, Kirstin N; Barrett, Tyler M; Duedu, Kwabena; Gonzales, Ernest; Ng, Nawi; Negin, Joel; Jiang, Yong; Byles, Julie; Madurai, Savathree Lorna; Minicuci, Nadia; Snodgrass, J Josh; Naidoo, Nirmala; Chatterji, Somnath

2017-03-15

In this paper, we examine patterns of self-reported diagnosis of noncommunicable diseases (NCDs) and prevalences of algorithm/measured test-based, undiagnosed, and untreated NCDs in China, Ghana, India, Mexico, Russia, and South Africa. Nationally representative samples of older adults aged ≥50 years were analyzed from wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (2007-2010; n = 34,149). Analyses focused on 6 conditions: angina, arthritis, asthma, chronic lung disease, depression, and hypertension. Outcomes for these NCDs were: 1) self-reported disease, 2) algorithm/measured test-based disease, 3) undiagnosed disease, and 4) untreated disease. Algorithm/measured test-based prevalence of NCDs was much higher than self-reported prevalence in all 6 countries, indicating underestimation of NCD prevalence in low- and middle-income countries. Undiagnosed prevalence of NCDs was highest for hypertension, ranging from 19.7% (95% confidence interval (CI): 18.1, 21.3) in India to 49.6% (95% CI: 46.2, 53.0) in South Africa. The proportion untreated among all diseases was highest for depression, ranging from 69.5% (95% CI: 57.1, 81.9) in South Africa to 93.2% (95% CI: 90.1, 95.7) in India. Higher levels of education and wealth significantly reduced the odds of an undiagnosed condition and untreated morbidity. A high prevalence of undiagnosed NCDs and an even higher proportion of untreated NCDs highlights the inadequacies in diagnosis and management of NCDs in local health-care systems. © The Author 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The Microbiome and Sustainable Healthcare

PubMed Central

Dietert, Rodney R.; Dietert, Janice M.

2015-01-01

Increasing prevalences, morbidity, premature mortality and medical needs associated with non-communicable diseases and conditions (NCDs) have reached epidemic proportions and placed a major drain on healthcare systems and global economies. Added to this are the challenges presented by overuse of antibiotics and increased antibiotic resistance. Solutions are needed that can address the challenges of NCDs and increasing antibiotic resistance, maximize preventative measures, and balance healthcare needs with available services and economic realities. Microbiome management including microbiota seeding, feeding, and rebiosis appears likely to be a core component of a path toward sustainable healthcare. Recent findings indicate that: (1) humans are mostly microbial (in terms of numbers of cells and genes); (2) immune dysfunction and misregulated inflammation are pivotal in the majority of NCDs; (3) microbiome status affects early immune education and risk of NCDs, and (4) microbiome status affects the risk of certain infections. Management of the microbiome to reduce later-life health risk and/or to treat emerging NCDs, to spare antibiotic use and to reduce the risk of recurrent infections may provide a more effective healthcare strategy across the life course particularly when a personalized medicine approach is considered. This review will examine the potential for microbiome management to contribute to sustainable healthcare. PMID:27417751

Using the effects of maternal nutritional indicators (hemoglobin and total protein) on baby's birth weight outcome to forecast a paradigm shift toward increased levels of non-communicable diseases in children.

PubMed

Ahmadu, Baba Usman; Yakubu, Nyandaiti; Yusuph, Haruna; Alfred, Marshall; Bazza, Buba; Lamurde, Abdullahi Suleiman

2013-01-01

Maternal malnutrition can lead to low birth weight in babies, which puts them at risk of developing non-communicable diseases later in life. Evidence from developed countries has shown that low birth weight is associated with a predisposition to higher rates of non-communicable diseases later in life. However, information on this is lacking in developing countries. Thus, this work studied the effects of maternal nutritional indicators (hemoglobin and total protein) on birth weight outcome of babies to forecast a paradigm shift toward increased levels of non-communicable diseases in children. Mother-baby pairs were enrolled in this study using systematic random sampling. Maternal haemogblobin and total proteins were measured using micro-hematocrit and biuret methods, and birth weights of their babies were estimated using the bassinet weighing scale. Of the 168 (100%) babies that participated in this study, 122 (72.6%) were delivered at term and 142 (84.5%) had normal birth weights. Mean comparison of baby's birth weight and maternal hemoglobin was not significant (P = 0.483), that for maternal total protein was also not significant (P = 0.411). Even though positive correlation coefficients were observed between birth weight of babies, maternal hemoglobin and total proteins, these were however not significant. Maternal nutrition did not contribute significantly to low birth weight in our babies. Therefore, association between maternal nutrition and low birth weight to predict future development of non-communicable diseases in our study group is highly unlikely. However, we recommend further work.

An exploratory study on risk factors for chronic non-communicable diseases among adolescents in Malaysia: overview of the Malaysian Health and Adolescents Longitudinal Research Team study (The MyHeART study)

PubMed Central

2014-01-01

Background The National Health & Morbidity Survey (NHMS) IV (2011) observed that the prevalence of obese children aged less than 18 years in Malaysia is 6.1% compared to 5.4% overweight and obese in NHMS III (2006). As such, this observation is of public health importance as obesity is a forewarning risk factor for chronic diseases such as type-2 diabetes, cardiovascular diseases (CVD) and certain types of cancers. This MyHeART (Malaysian Health and Adolescents longitudinal Research Team) study aims to examine risk factors of non-communicable diseases (NCD) among adolescents. Methods/design The MyHeART study is longitudinal cohort study of 1361 schoolchildren (13-years old) attending 15 public secondary schools from the central (Kuala Lumpur and Selangor) and northern (Perak) regions of Peninsular Malaysia. The study used a stratified sampling design to select the study participants. Data collected at baseline included socio-economic, lifestyle (e.g. smoking, physical activity assessment, fitness assessment, seven-day diet history), and environmental information, anthropometric measurements, blood pressure, handgrip strength and bone mineral density. Blood samples for fasting blood glucose and lipid profiles, full blood count, renal profile, as well as bone profile and serum vitamin D were taken. This study cohort will be followed up again when participants turn 15, 17 and lastly, after a period of ten years (around the age of 27). Results Nine percent of the adolescents from this study were obese. More male participants smoked compared to female participants (15.4% vs. 4.7%). Adolescent males had higher fasting blood glucose but the female participants had lower high density lipoprotein (HDL-cholesterol) and higher low density lipoprotein (LDL-cholesterol). In addition, adolescents from the rural area had higher fasting blood glucose, diastolic blood pressure, total cholesterol and LDL-cholesterol. Discussion Our results demonstrated that adolescents from the

Healthy fats for healthy nutrition. An educational approach in the workplace to regulate food choices and improve prevention of non-communicable diseases.

PubMed

Volpe, Roberto; Stefano, Predieri; Massimiliano, Magli; Francesca, Martelli; Gianluca, Sotis; Federica, Rossi

2015-12-01

An educational activity, aimed at highlighting the benefits of Mediterranean Diet, compared to less healthy eating patterns, can encourage the adoption and maintenance of a mindful approach to food choice. This is especially important when a progressive shift towards a non-Mediterranean dietary pattern can be observed, even in Mediterranean countries. To test a protocol aimed at increasing knowledge and motivation to embrace healthy eating habits and, engendering conscientious food choices, improve the prevention of non-communicable diseases. Employees were involved in educational activities focusing on a healthy Mediterranean diet and on the role played by extra-virgin olive oil, one of its key components. Food questionnaires were completed both before and after the educational and information activities, in order to assess changes in personal knowledge of and attitudes towards fat consumption. Answers on dietary guidelines and fat properties were more accurate after the seminars. The results showed increased understanding of the properties of extra-virgin olive oil versus seed oil and a stronger tendency towards healthy food choices. Implementing preventive information and training strategies and tools in the workplace, can motivate a more mindful approach to food choice with the long-term goal of contribute to reducing non-communicable diseases.

Hormonal Contraception and Risk of Psychiatric and Other Noncommunicable Diseases in HIV-Infected Women

PubMed Central

Jenkins, Cathy A.; Shepherd, Bryan E.; Bebawy, Sally S.; Turner, Megan; Sterling, Timothy R.; Melekhin, Vlada V.

2015-01-01

Abstract Background: Hormonal contraception use is common among human immunodeficiency virus (HIV)-infected women. Risk of psychiatric and other noninfectious complications of hormonal contraception use has not been described in this population. Methods: We performed a retrospective cohort study of HIV-infected women receiving care in Tennessee from 1998 to 2008 to examine the risks of incident psychiatric and other noncommunicable diseases (NCDs), including cardiovascular, hepatic, renal, and malignant diseases, and hormonal contraception use, including depot medroxyprogesterone acetate (DMPA) and combined estrogen- and progestin-containing hormonal contraceptives. We used marginal structural models with inverse probability weights to account for time-varying confounders associated with hormonal contraception use. Results: Of the 392 women included, 94 (24%) used hormonal contraception during the study period. Baseline psychiatric disease was similar between women who received and did not receive hormonal contraception. There were 69 incident psychiatric diagnoses and 72 NCDs. Only time-varying DMPA use was associated with increased risk of psychiatric disease (adjusted odds ratio [aOR] 3.70; 95% confidence interval [95% CI] 1.32–10.4) and mood disorders, specifically (aOR 4.70 [1.87–11.8]). Time-varying and cumulative combined hormonal contraception use were not statistically associated with other NCDs (aOR 1.64, 95% CI 0.64–4.12 and aOR 1.16, 95% CI 0.86–1.56, respectively). However, risk of incident NCDs was increased with cumulative DMPA exposure (per year exposure aOR 1.45, 95% CI 1.01–2.08). Conclusions: Among HIV-infected women, DMPA was associated with risk of incident psychiatric diseases, particularly mood disorders, during periods of use. Cumulative DMPA exposure was also associated with risk of other NCDs. However, combined estrogen and progestin-containing hormonal contraception use was not statistically associated with risk of any NCDs

Tackling the global NCD crisis: innovations in law and governance.

PubMed

Thomas, Bryan; Gostin, Lawrence O

2013-01-01

35 million people die annually of non-communicable diseases (NCDs), 80% of them in low- and middle-income countries - representing a marked epidemiological transition from infectious to chronic diseases and from richer to poorer countries. The total number of NCDs is projected to rise by 17% over the coming decade, absent significant interventions. The NCD epidemic poses unique governance challenges: the causes are multifactorial, the affected populations diffuse, and effective responses require sustained multi-sectorial cooperation. The authors propose a range of regulatory options available at the domestic level, including stricter food labeling laws, regulation of food advertisements, tax incentives for healthy lifestyle choices, changes to the built environment, and direct regulation of food and drink producers. Given the realities of globalization, such interventions require global cooperation. In 2011, the UN General Assembly held a High-level meeting on NCDs, setting a global target of a 25% reduction in premature mortality from NCDs by 2025. Yet concrete plans and resource commitments for reaching this goal are not yet in the offing, and the window is rapidly closing for achieving these targets through prevention - as opposed to treatment, which is more costly. Innovative global governance for health is urgently needed to engage private industry and civil society in the global response to the NCD crisis. © 2013 American Society of Law, Medicine & Ethics, Inc.

Gender blind? An analysis of global public-private partnerships for health.

PubMed

Hawkes, Sarah; Buse, Kent; Kapilashrami, Anuj

2017-05-12

The Global Public Private Partnerships for Health (GPPPH) constitute an increasingly central part of the global health architecture and carry both financial and normative power. Gender is an important determinant of health status, influencing differences in exposure to health determinants, health behaviours, and the response of the health system. We identified 18 GPPPH - defined as global institutions with a formal governance mechanism which includes both public and private for-profit sector actors - and conducted a gender analysis of each. Gender was poorly mainstreamed through the institutional functioning of the partnerships. Half of these partnerships had no mention of gender in their overall institutional strategy and only three partnerships had a specific gender strategy. Fifteen governing bodies had more men than women - up to a ratio of 5:1. Very few partnerships reported sex-disaggregated data in their annual reports or coverage/impact results. The majority of partnerships focused their work on maternal and child health and infectious and communicable diseases - none addressed non-communicable diseases (NCDs) directly, despite the strong role that gender plays in determining risk for the major NCD burdens. We propose two areas of action in response to these findings. First, GPPPH need to become serious in how they "do" gender; it needs to be mainstreamed through the regular activities, deliverables and systems of accountability. Second, the entire global health community needs to pay greater attention to tackling the major burden of NCDs, including addressing the gendered nature of risk. Given the inherent conflicts of interest in tackling the determinants of many NCDs, it is debatable whether the emergent GPPPH model will be an appropriate one for addressing NCDs.

Emerging chronic non-communicable diseases in rural communities of Northern Ethiopia: evidence using population-based verbal autopsy method in Kilite Awlaelo surveillance site.

PubMed

Weldearegawi, Berhe; Ashebir, Yemane; Gebeye, Ejigu; Gebregziabiher, Tesfay; Yohannes, Mekonnen; Mussa, Seid; Berhe, Haftu; Abebe, Zerihun

2013-12-01

In countries where most deaths are outside health institutions and medical certification of death is absent, verbal autopsy (VA) method is used to estimate population level causes of death. VA data were collected by trained lay interviewers for 409 deaths in the surveillance site. Two physicians independently assigned cause of death using the International Classification of Diseases manual. In general, infectious and parasitic diseases accounted for 35.9% of death, external causes 15.9%, diseases of the circulatory system 13.4% and perinatal causes 12.5% of total deaths. Mortalities attributed to maternal causes and malnutrition were low, 0.2 and 1.5%, respectively. Causes of death varied by age category. About 22.1, 12.6 and 8.4% of all deaths of under 5-year-old children were due to bacterial sepsis of the newborn, acute lower respiratory infections such as neonatal pneumonia and prematurity including respiratory distress, respectively. For 5-15-year-old children, accidental drowning and submersion, accounting for 34.4% of all deaths in this age category, and accidental fall, accounting for 18.8%, were leading causes of death. Among 15-49-year-old adults, HIV/AIDS (16.3%) and tuberculosis (12.8%) were commonest causes of death, whereas tuberculosis and cerebrovascular diseases were major killers of those aged 50 years and above. In the rural district, mortality due to chronic non-communicable diseases was very high. The observed magnitude of death from chronic non-communicable disease is unlikely to be unique to this district. Thus, formulation of chronic disease prevention and control strategies is recommended.

Health Service Utilization among Syrian Refugees with Chronic Health Conditions in Jordan.

PubMed

Doocy, Shannon; Lyles, Emily; Akhu-Zaheya, Laila; Oweis, Arwa; Al Ward, Nada; Burton, Ann

2016-01-01

The influx of Syrian refugees into Jordan presents an immense burden to the Jordanian health system, particularly in treating chronic health conditions. This study was undertaken to assess utilization of health services for chronic health conditions among Syrian refugees in non-camp settings. A survey of Syrian refugees in Jordan was undertaken in June 2014 to characterize health seeking behaviors and issues related to accessing care for hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, and arthritis. A cluster design with probability proportional to size sampling was used to attain a nationally representative sample of 1550 non-camp Syrian refugee households. Of 1363 cases with a chronic health condition diagnosis, 84.7% had received care in Jordan. Public facilities faced a heavy burden serving over half (53.9%) of care-seekers; the remainder received care in the private (29.6%) and NGO/charity (16.6%) sectors. Individuals with non-communicable diseases (NCDs) in the central region of Jordan and with arthritis had the lowest rates of care-seeking when compared to other regions and conditions. Overall, 31.6% of care-seekers had an out-of-pocket payment for the most recent care-seeking event which averaged 18.8 USD (median = 0 USD), excluding cost of medications. Forced displacement presents major challenges to those with NCDs, which have the potential to seriously impact both the quality of life and life expectancy amongst refugees. NCD patterns among Syrian refugees indicate the importance of continuing support to public sector services in Jordan to adequately meet expanding needs and ensure appropriate prevention and control of priority NCDs.

Potential for mobile health (mHealth) prevention of cardiovascular diseases in Kerala: A population-based survey.

PubMed

Feinberg, Leo; Menon, Jaideep; Smith, Rebecca; Rajeev, Jaya G; Kumar, Raman Krishan; Banerjee, Amitava

India's southern state of Kerala stands at the forefront of India's epidemic of cardiovascular disease (CVD), among other non-communicable diseases (NCDs). Mobile phone use in healthcare (mHealth) has shown promise in India, including NCDs. However, suitability and acceptability of m-Health interventions is poorly researched, particularly in rural settings. METHODS: A questionnaire regarding mobile phone usage and possible use in healthcare was verbally administered in five primary health centres and by home visits in five village councils ("panchayats") of Ernakulam, Kerala. Adults who spoke Malayalam or English, with access to a mobile phone were recruited by convenience sampling in partnership with accredited social health activists (ASHAs). Quantitative data analysis was conducted using SPSS software. 262 participants were recruited. 87% routinely used and 88% owned a mobile phone. 92% were willing to receive mHealth advice, and 94% favoured mobile medication reminders. 70.3% and 73% preferred voice calls over short messaging service (SMS) for delivering health information and medication reminders, respectively. 85.9% would send home recorded information on their blood pressure, weight, medication use and lifestyle to a doctor or ASHA. 75.2% trusted the confidentiality of mHealth data, while 77.1% had no concerns about the privacy of their information. The majority of this population approve mHealth interventions. While further investigation of mHealth as a health education tool is warranted, SMS interventions may fail to maximise equity and penetration across all patient groups. Copyright © 2016 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Non-verbal communication: the importance of listening.

PubMed

Kacperek, L

This article presents the author's personal reflection on how her nursing practice was enhanced as a result of losing her voice. Surprisingly, being unable to speak appeared to improve the nurse/patient relationship. Patients responded positively to a quiet approach and silent communication. Indeed, the skilled use of non-verbal communication through silence, facial expression, touch and closer physical proximity appeared to facilitate active listening, and helped to develop empathy, intuition and presence between the nurse and patient. Quietly 'being with' patients and communicating non-verbally was an effective form of communication. It is suggested that effective communication is dependent on the nurse's ability to listen and utilize non-verbal communication skills. In addition, it is clear that reflection on practical experience can be an important method of uncovering and exploring tacit knowledge in nursing.

International law and communicable diseases.

PubMed Central

Aginam, Obijiofor

2002-01-01

Historically, international law has played a key role in global communicable disease surveillance. Throughout the nineteenth century, international law played a dominant role in harmonizing the inconsistent national quarantine regulations of European nation-states; facilitating the exchange of epidemiological information on infectious diseases; establishing international health organizations; and standardization of surveillance. Today, communicable diseases have continued to re-shape the boundaries of global health governance through legally binding and "soft-law" regimes negotiated and adopted within the mandate of multilateral institutions - the World Health Organization, the World Trade Organization, the Food and Agriculture Organization, and the Office International des Epizooties. The globalization of public health has employed international law as an indispensable tool in global health governance aimed at diminishing human vulnerability to the mortality and morbidity burdens of communicable diseases. PMID:12571722

Communicable Diseases in Childhood Settings.

ERIC Educational Resources Information Center

Networks, 1994

1994-01-01

This newsletter addresses managing the spread of communicable diseases in childhood settings as well as educational program concerns for children who are HIV infected. Noting that communicable diseases are a source of concern no matter how minor they might appear, the newsletter suggests that it is important for individuals who work with the…

The preconceptional period as an opportunity for prediction and prevention of noncommunicable disease.

PubMed

Hadar, Eran; Ashwal, Eran; Hod, Moshe

2015-01-01

Preconceptional care is a set of interventions, aimed to identify and modify medical, behavioral, and social risks to a woman's health and her pregnancy outcome, prior to conception. Diagnosing and treating some of the common noncommunicable diseases (NCDs) may have an impact on pregnancy outcome. Ample time should be allowed to properly intervene in some of the following situations: hypertension, diabetes, obesity, systemic lupus erythematosus, thyroid disease, anemia, epilepsy, asthma, and cardiac disease. Diabetes mellitus and obesity are common NCDs, with proven efficacy for preconceptional care, for both maternal and perinatal outcome. These primary components of the metabolic syndrome, if properly treated prior to pregnancy, will prevent long-term hazards for the mother, her children, and the next generations, by providing in utero primary prevention of NCDs. Copyright © 2014 Elsevier Ltd. All rights reserved.

42 CFR 70.3 - All communicable diseases.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false All communicable diseases. 70.3 Section 70.3 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES QUARANTINE, INSPECTION, LICENSING INTERSTATE QUARANTINE § 70.3 All communicable diseases. A person who has a communicable disease in the...

42 CFR 70.3 - All communicable diseases.