UMANAND PRASAD SCHOOL OF

MEDICINE & HEALTH SCIENCE

COMMUNITY MEDICINE 405 PRESENTATION
2021
NON COMMUNICABLE DISEASES
PRESENTERS: MALLIKA PRASAD 20180103
NEHA RAM 20180149
ASHNA LAL 20180224
HARSHANI RAJ 20170362
TANVI LAXMI 20180200
SERA QATIVI 201700550
LUSIANA SALATA 20170447
MAKELESI NASILIVATA 20180057
SAMUEL RAKESH 20180302
AKASH SAMI 20180125
COURSE COORDINATOR: DR MARIA CABIO
INTRODUCTION
• Non-communicable disease (NCD) is a chronic disease, tend to be of long
duration and are result of a combination of genetic, physiological, environmental
and behavioural factors.
• NCDs are preventable diseases through lifestyle modification.
MAJOR NON-COMMUNICABLE DISEASES
SEEN IN FIJI
There are 4 main types of NCD;
1. Cardiovascular Disease
2. Diabetes
3. Respiratory Disease
4. Cancers
EPIDEMIOLOGY
NON-COMMUNICABLE COMMUNICABLE DISEASES
DISEASES
• There are 141754944 COVID19 cases
• Around 80% of deaths in Fiji are
reported globally, 3025835 deaths and 223
caused by an NCD and those numbers
countries were affected (21st April 2021).
are growing.
• With the adverse weather conditions, there
• Each year, 41 million people die from
have been emphasis on the prevention of
an NCD of which 15 million people
communicable diseases like leptospirosis,
are between ages 30 and 69.
typhoid, dengue fever and influenza in the
• In 2018, Fiji recorded the highest country.
death rate from diabetes compared to
• Measles outbreak declared on 7th November
any other country with 188 fatalities
2019- Mass Immunization Campaign
per 100,000.
SOME COMMON NCDs IN
FIJI
WHAT IS A STROKE
• Stroke occurs when the blood supply to an area of the brain is cut off. As a result it
destroys the brain cells deprived of the oxygen and glucose.
• A stroke can result into death or can cause permanent disability.
• Anyone can have stroke regardless of their age, sex, ethnicity or race.
• In Fiji stroke is seen as a rising incident over the past few decades.
 TYPES OF STROKE
• There are three types of strokes:
i. Ischemic stroke
ii. Hemorrhagic stroke
iii. Transient ischemic attack
ISCHEMIC STROKE
• It is similar to a heart attack, except it occurs in the blood vessels of the brain.
• Clots can form either in the brain’s blood vessels, in blood vessels leading to the
brain, or even blood vessels elsewhere in the body which then travel to the brain.
• These clots block blood flow to the brain’s cells. Ischemic stroke can also occur
when too much plaque (fatty deposits and cholesterol) clogs the brain’s blood
vessels.
• About 80% of all strokes are ischemic stroke.
HEMORRHAGIC STROKE
• It occurs when a blood vessel in the brain breaks or ruptures. The result is blood
seeping into the brain tissue, causing damage to brain cells.
• The most common causes of hemorrhagic stroke are high blood pressure and brain
aneurysms.
• An aneurysm is a weakness or thinness in the blood vessel wall that causes it to
balloon outward.
TRANSIENT ISCHEMIC ATTACK (TIA)
• It is often called a “mini-stroke,” may be a warning of an impending stroke.
• It typically consists of the same signs and symptoms of stroke, but the symptoms
are temporary.
• It occurs when blood flow to a certain part of the brain is cut off for a short period
of time, usually 15 minutes or less.
• A TIA can occur anywhere from a few minutes to several months before a stroke.
A TIA is a painless episode, but it is a warning that something is wrong. It should
be treated as seriously as a stroke.
WARNING SIGNS OF STROKE
❖ F.A.S.T
• Facial weakness - does the face look uneven?
• Arm weakness - does the arm drift down?
• Difficulty with speech- does the speech sound strange
• Time- it is critical, act fast and seek help
❖ D.A.N.G.E.R
• Dizziness resulting in loss of balance and coordination.
• Altered behaviour and unusual sudden strong bursts of anger or hostility.
• Numbness, weakness or paralysis of the face, arm, leg or one side of the body.
• Garbled speech or confused thinking or understanding.
• Eye problems, loss of sight in one or both eyes or double vision
• Responses to stimulus is slow
DIAGNOSIS
• CT scan
• MRI
• Physical examination
• Blood tests
• Carotid ultrasound
• Cerebral angiogram
• Echocardiogram
EFFECTS OF STROKE
❖ A stroke could affect any or all of the following short-term, long-term or
permanently;
• Speech
• Eyesight
• Memory
• Strength and movement in arms and/or legs
• Balance
• Walking
• Sensation (physical feeling)
• Understanding of space and directions
• Control of emotions like laughing and crying
• Bladder control
TREATMENT

GOLDEN HOUR
• The reason the first hour is golden is because stroke patients have a
much greater chance of surviving and avoiding long-term brain
damage if they arrive at the hospital and receive treatment with a
clot-busting drug called TPA within that first hour.
 TREATMENT FOR STROKE
i. History taking
ii. Neuro-examination
iii. Investigations prioritize head CT scan
hypodense (infarct) hyperdense (bleed)

300mg Aspirin stat no Aspirin

Gradual BP control aggressive BP control
monitor
for any (complications)
HOW TO REDUCE RISKS OF STROKE
• There are some simple steps you can take to reduce your risk of a S.T.R.O.K.E.
• See your Doctor regularly and if you smoke, STOP
• Test for high blood pressure and diabetes
• Required medication taken according to Doctor’s directions
• Overweight persons should change dietary habits and eat healthy for a better,
longer life
• Keep alcohol and yaqona consumption at a reasonable level
• Exercise regularly and reduce stress
DIABETES

• Diabetes is a chronic condition associated with abnormally high levels of sugar

(glucose) in the blood.
 TYPES
Type 1
• The pancreas (an organ behind your stomach) produces little insulin or no insulin at all. Insulin is
a naturally occurring hormone, produced by the beta cells of the pancreas, which helps the body
use sugar for energy.
• Is characterized by progressive beta cell destruction, severe insulin deficiency, and the urgent need
for insulin replacement therapy because of the risk of ketoacidosis and death.

Type 2
• The pancreas makes insulin, but the insulin made doesn't work as it should. This condition is
called insulin resistance.
• Is common and is the predominant form of diabetes.

Gestational diabetes
• Pregnant women can also develop diabetes. This is called gestational diabetes (or ‘diabetes in
pregnancy’). It usually goes away when the baby is born.
PATHOPHYSIOLOGY
SIGNS AND SYMPTOMS
• Increase urine output
• Excessive thirst
• Slow healing wounds
• Yeast infections
• Tingling or numbness in the feet or
toes
• Skin problems
• Blurred vision
• Dry mouth
• Weight loss/gain
• Hyperglycaemia- when the body has too little insulin or when the body can't
use insulin properly.

Signs and Symptoms

• High blood sugar
• High levels of sugar in the urine
• Frequent urination
• Increased thirst
• Hypoglycaemia- a condition in which your blood sugar (glucose) level is lower than normal.
• Hypoglycemia is a condition defined as a fall in the blood sugar level over a short period of time
causing symptoms

Signs and Symptoms

HE IS TIRED
• He – headache
• I- irritable
• S – sweating or shaking
• T – tachycardia or trembling
• I – impatience
• R – restlessness
• E – excessive hunger
• D – dizziness
DIAGNOSIS
TREATMENT
• Metformin-500mg
• Glipizide- 5mg

• Insulin- injections given in the abdominal wall, the deltoids and the thighs
• Insulin pen- reusable and disposable
DEFINITON
• Asthma is a common chronic inflammatory disorder of the airways. (obstructive
lung disease)
• The chronic inflammation causes an associated increase in airway
hyper-responsiveness that leads to recurrent episodes of wheezing, breathlessness,
chest tightness, and coughing, particularly at night or in the early morning.
• usually associated with widespread but variable airflow obstruction that is
reversible spontaneously or with treatment.
PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS
• Severe dyspnea
(wheezing with expiration or inspiration)
• Tachypnea
• Cough
• Feelings of chest tightness
• Prolonged expiration
• Diminished breath sounds
• Increased heart rate and blood pressure
• Restlessness, anxiety and agitation
DIAGNOSIS
History taking
Skin test
Physical examination
Pulmonary function test
• Peak flow meter
• Spirometry
Sputum analysis
Complete blood count
Chest x – rays
Pulse oximetry
ABG analysis
MANAGEMENT
• Prevention or reduction of the severity of attacks
• Treatment of acute attacks and
• Where necessary, long-term medication which works best with strict adherence.
a. Oxygen
b. Beta adrenergic agonist
c. Anticholinergic
d. Corticosteroids
CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
(COPD)
INTRODUCTION

• Chronic Obstructive Pulmonary disease in simple terms is defined as limitation of

airflow in the lungs.
• Is a preventable and treatable disease
• COPD is characterized by persistent airflow obstruction which is progressive and
associated with inflammatory response of lungs due to noxious stimuli
• Commonly affects middle aged and older people and cigarette smoking is said to
be the major causative factor of the disease.
• Most common condition that leads to COPD are Chronic Bronchitis and
Emphysema.
RISK FACTORS
• Cigarette Smoking
• Advanced age
• Occupational exposures (coal dust, silica)
• Genetic factors
• Low socioeconomic status
• Cannabis smoking
CHRONIC BRONCHITIS
• Defined clinically as a cough productive of sputum occurring on a daily basis for three (3)
months in each of two consecutive years.
 EMPHYSEMA
• It is when the lung parenchyma is damaged. Destruction of the alveoli septa and
formation of abnormally enlarged air spaces.
CLINICAL FEATURES
INVESTIGATION
• Chest Xray
• Spirometry test (FEV1/FVC ratio <70%)
• FBC
• Helium dilution technique (assess hyperinflation)
Barrel Chest Hyperinflation
MANAGEMENT
• Smoking cessation
• Maintaining a healthy weight
• Nutrition- high fibre foods, high protein foods, fruits and vegetables is
recommended
• Avoid non nutritious beverages e.g. black coffee and tea
• Bronchodilators (long-term)
Salbutamol 100-200 micrograms by inhalation 4 times daily
OR
Ipratropium bromide 40-80 micrograms by inhalation 4 times daily
• Inhaled Corticosteroids (long-term)
Beclomethasone dipropionate 300-400 micrograms by inhalation twice daily
CANCER
• Cancer is one of the four main non-communicable diseases in Fiji and around the world.
• Cancer is the general name for a group of more than 100 diseases. Although there are
many kinds of cancer, all cancers start because abnormal cells grow out of control.
Untreated cancers can cause serious illness and death.
• Cancer has become a global epidemic and affects people of all ages. Unfortunately,
cancer cases in Fiji have steadily increased over the past several years and it is now the
3rd most common cause of death in Fiji.
• In Fiji, statistics reveal that there is mostly an increasing incidence of breast, cervix and
other reproductive tract cancers in women. In men cancers such as prostate, liver, rectum
and lung cancer are becoming more common.
Common Cancers in Fiji
Common cancers in males Common cancers in females
1) Liver cancer 1) Cervical cancer
2) Prostate cancer 2) Breast cancer
3) Lung cancer 3) Uterine cancer
4) Stomach cancer 4) Ovarian cancer
5) Colon cancer 5) Liver cancer

Source: Ministry of Health

Causes of Cancer
Cancer is a very complex group of diseases with many potential causes. There are several
known factors that can increase your risk of cancer, many of which are lifestyle factors that
are within your control to change.
Known Causes of cancer include;
• Genetics
• Tobacco Use
• Bad Diet
• Physical Inactivity
• Sun and UV exposure
• Radiation
• Other Carcinogens (environmental causes)
Warning Signs of Cancer
• Abnormal menstruation
• Back pain
• Bloated belly
• Pelvic and abdominal pain
• Constipation
• Difficulty eating
• Nausea and vomiting
• Fatigue
• Urinary symptoms
• Painful sex
Source: Ministry of Health
TREATMENT
• Cancer treatment may include chemotherapy, radiation, and/or surgery. Treatment can
depend on the type of cancer, how advanced it is and what treatment is available.
• Currently all cancer cases are being managed in the 3 divisional hospitals (Oncology
Units). The local treatment used is in the form of surgical intervention and limited
chemotherapy. Those requiring radiotherapy are referred overseas through Government
assistance.
• Chances of beating cancer are much greater if it is caught early, so be aware of your body
and the symptoms and ask your doctor if you have any concerns.
STATISTICS

Source: Ministry of Health

Source: WHO, International
Ministry of Health: Action on Cancer
The Health Ministry remains committed towards the reduction of cancer morbidity and
mortality, improving the survival rates of cancer cases and improving the quality of life of
cancer victims.
Since 2009 the Health Ministry has made vast improvements in terms of new advocacy and
prevention programs including;
• Improved national database in collating cancer statistics.
• A newly set up liquid Cytology screening lab.
• Introduction of HPV virus vaccination initiative supported by the Fiji and Australian
Governments.
• V.I.A (Visual Inspection with Acetic acid and Cyro-cautery) as cost effective means to
treat precancerous lesions on the cervix undergoing trials.
• A rudimentary Domiciliary Palliative Service is operational in Suva and the West with the
support of the Fiji Cancer Society.
• Fiji has become a member state of the International Atomic Energy Agency (IAEA) and
representatives from the International Atomic Energy Commission will be here to assist in
the establishment of a cancer hospital supported by the government, (the first of its kind
in the Pacific Region). Having a Cancer Hospital will centralize all the relevant treatment
and management protocols and provide a serene environment for patients and families.
• The Health Ministry through its Wellness Concept has continuously advocated and
created awareness on cancer prevention and control program through healthy lifestyle.
• The Health Ministry is working with the International Women Agencies and is the final
stages of setting up a wellness centre for women in Suva. We are also working in
partnership with UNFPA and other agencies towards the setting up of a wellness centre in
Lautoka. This centre will provide awareness ,information and services to women on
sexual, reproductive health, cancer screenings and counselling sessions.
COMMON RISK FACTOR OF NCDs
HYPERTENSION
• It is one of the major NCDs in Fiji
• Hypertension aka high blood pressure.
• Is a condition in which the vessels have persistently raised.
• Normal blood pressure – 120/80.
RISK FACTORS
SIGNS AND SYMPTOMS
• Severe headaches
• Chest pain
• Palpitations
• Shortness of breath
• Severe dizziness or feeling faint
• Vision changes
• Weakness, numbness, tingling in the arms, legs, or face on one or both sides
• Trouble speaking or understanding words
• Confusion or behavioral changes
MANAGEMENT
Pharmacological Management
• Hydrochlorothiazide 12.5-25mg
• Atenolol 25-100mg
• Propranolol 40-80mg
• Nifedipine 20-40mg
• Enalapril 2.5-4.mg
• Frusemide 40-80mg
Nonpharmacological Management
• Weight loss
• Diet
• Psychotherapy
 NUTRITIONAL PLAN

Grains: 7-8 daily servings

Vegetables: 4-5 daily servings

Fruits: 4-5 daily servings

Low-fat or fat-free dairy products: 2-3

daily servings

Meat, poultry, and fish: 2 or less daily

servings
GENERAL HEALTH SCREENINGS
AND PREVENTION FOR NCD
SCREENING
• A health screening is the process of detecting diseases or medical conditions in
healthy people.

Importance
It helps detect diseases and medical conditions at an early stage so that it can allow
for early intervention which can give better outcomes
GENERAL HEALTH SCREENING
• Blood Pressure
• Height and Weight
• Body Mass Index
• Physical examination
• Vision Test
-color vision
-visual acuity
• Urine Analysis
• Blood investigation
• Blood count
• Cholesterol profile
• Fasting glucose
• Kidney function Test
• Liver function Test
GREEN PRESCRIPTION
It is a health professional’s written advice to support the patient to increase their
physical activity and is usually developed in collaboration with the patient.
NCD PREVENTIVE MEASURES
S.N.A.P
• S- Smoking
• N- Nutrition
• A- Alcohol
• P- Physical Inactivity
SMOKING
• According to the 2011 STEPS survey, 16.6% of Fijians smoke everyday.
• Nowadays people start smoking at a younger age.
TIPS TO QUIT SMOKING- START
• S – set a quit date

• T – tell family and friends you plan on quitting

• A- anticipate and plan for any challenges you may face while trying to quit

• R – Remove any cigarettes or tobacco products from your surrounding

• T – think positive
NUTRITION
ALCOHOL
 RECOMMENDED LEVELS OF
DRINKING
Females
• No more than 2 standard drinks per day
Or
• 10 standard drinks a week with at least 2 alcohol free days
*but no more than 4 standard drinks on any occasion

Males
• No more than 3 standard drinks per day
Or
• 15 standard drinks a week with at least 2 alcohol free days
*but no more than 5 standard drinks per occasion
How long the body takes to process alcohol
 SHORT-TERM EFFECTS OF DRINKING
ALCOHOL
1-2 standard drinks
• Increase in heart rate ,causes blood vessels to expand and gives the warm, sociable
and talkative feeling
4-6 standard drinks
• Brain and nervous system starts to get affected
• Impaired judgment and decision making
• Feel light-headed and have coordination problems
8-9 standard drinks
• Slow reaction time
• Slurred speech ,blurred vision
 SHORT-TERM EFFECTS OF DRINKING
ALCOHOL
10 – 12 units
• Coordination highly impaired
• Drowsy feeling
• Will leave you feeling dehydrated in the morning

More than 12 units

• At risk of developing alcohol poisoning
TIPS ON CUTTING DOWN ALCOHOL
• Make a plan
• Set a budget
• Inform family and friends of your plan to cut down on alcohol
• Take one day at a time
• Slowly reduce the size of drink
• Slowly switch to a lower strength drink
• Stay hydrated
• Take a break
• Take a longer break
PHYSICAL ACTIVITY
• Is any bodily movement that results in energy expenditure
• Can be done anywhere, anytime and requires no special equipment
• Can be a sport, gardening, farming, housework, cycling, walking or anything
physical that has you moving
Physical Activity also lowers the risk of premature death and many diseases and
conditions such as:

• Heart disease
• Stroke
• Type 2 diabetes
• High blood pressure
• High blood cholesterol
• Some types of cancer- colon, breast, lung
• Depression and anxiety
THE WELLNESS
APPROACH
DOMICILIARY CARE
• Is defined as the range of services put in place to support an individual in their
own home
• Services may involve routine household tasks within or outside the home, personal
care of the client and other associated domestic services necessary to maintain an
individual in an acceptable level of health ,hygiene, dignity ,safety and ease in
their home.
PEN MANAGEMENT
• The WHO Package of Essential Noncommunicable Disease Interventions (WHO
PEN) for primary care in low-resource settings is an innovative and
action-oriented set of cost-effective interventions that can be delivered to an
acceptable quality of care, even in resource-poor settings.
• These tools will enable early detection and management of cardiovascular
diseases, diabetes, chronic respiratory diseases and cancer to prevent life
threatening complications (e.g. heart attacks, stroke, kidney failure, amputations,
blindness).
What are the MOH initiatives and newer
strategies in control of NCDs?
MOH INITIATIVES & NEW STRATEGIES
IN CONTROL OF NCD
• NCD Prevention and Control National Strategic Plan 2010-2014 had two priority
areas and under each priority area were 4 components.
• NCD Risk Factors intervention
• Smoking
• Nutrition
• Alcohol
• Physical Activity
• The NCD Medical Intervention
• Diabetes Mellitus
• Cardiovascular Diseases
• Cancers
• Accidents and Injuries
• Strategic Plan 2015-2019 goal was to contribute to the overall goal of a healthier
Fiji, and specifically to achieve a 25% reduction in premature mortality from the
four key NCDs by 2025.
• Commitment to this goal required:
• Multi-sectoral approach.
• Improved service delivery with integration of prevention, early diagnosis and
treatment at all levels of primary health care.
• Improved monitoring and evaluation.
• Building capacity to deliver these services.
• Strategic plan 2020 – 2025 aims to provide a one system approach to three core
strategic priorities and to achieve UHC through the quality health care necessary
for good health.
What do you think about the success and
failure of MOH NCDs Programme?
Success
• Free screening services have enabled public to start on early treatment
• Early detection of NCDs
• Reduction in NCD rates since they have started giving screening services to
people’s homes
• Banning of junk foods sold in school canteens and providing healthier alternatives
Failure
•Lack of constant awareness
•There is not enough enforcement put into place for such programs or healthy living
(eg: Government should look into the prices of healthy food compared to the prices
of junk food)
•Smoking and alcohol abuse still remains high.
DO YOU BELIEVE THAT NCDs COULD BE
EFFECTIVELY HALTED BY YOUR
GRADUATION?
• NCD is caused by an individual’s choice of lifestyle.
• After we graduate, the best we can do is raise awareness on the effects of poor
lifestyle choices.
• Whether or not the public will listen, that is their choice.
• If the public chooses to listen, then yes, NCD’s can be halted after we graduate. If
the public doesn’t heed our warnings, then no. NCD’s will not be halted after we
graduate
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[Accessed 22 April 2021].
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[Accessed 22 April 2021].
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• Respiratory Drug Guidelines, first edition 2008 pp 47