Introduction:

Non-communicable diseases (NCDs) are a class of chronic diseases that cannot be transmitted from one
person to another and are not contagious .This type of diseases has a prolonged course that does not
resolve spontaneously, and for which a complete cure is rarely achieved.These diseases are generally
caused by lifestyle choices like poor eating habits, inactivity, smoking, and binge drinking. The main
contributors to disease impact currently are non-communicable diseases (NCDs) . According to
estimates from the World Health Organization (WHO), NCDs are to blame for 71% of all fatalities
worldwide, with 85% of NCD-related premature deaths happening in  low and middle income
countries.Around the world ,NCDs affect men and women almost equally.

Charecteristics of Non communicable disease:

The common attributes of NCDs are as follows:

• Intricate causes

• Numerous risk factors

• Delayed onset

• Not contagious in nature (non-communicable)

• Extended duration of illness

• Hindrance to functionality or disability

Classification
The World Health Organization (WHO) classifies noncommunicable illnesses into four basic categories:

• cancer

Cardiovascular disorders (e.g., heart attacks and stroke)

• chronic respiratory diseases (e.g., asthma and chronic obstructive pulmonary disease)

• diabetes
 NCDs are responsible for 71% of the 57 million global death

cardiovascular disease 31%

cancer 16%
Chronic respiratory disease
7%
Diabetes 3
Maternal,perinatal and nu-
tritional conditions 20%
Other NCDs 15%

Major Risk Factors of NCDS:

Definition:

An aspect of personal behavior or lifestyle, an environmental exposure, or a hereditary characteristic

that is associated with an increase in the occurrence of a particular disease, injury, or other health
condition.

Classification of risk factor of NCDs:

i)Non-modifiable risk factor:

Non-modifiable risk factors are inherent to an individual and cannot be altered. They include
factors such as age, family history, and sex, which are beyond an individual's control.
Age:There is an increased risk of developing NCDs such as high blood pressure, high blood sugar
levels, and high levels of body fat and blood fats, which can lead to heart and blood vessel
diseases, diabetes, cancer, and respiratory problems.
Sex:Both men and women are at risk of developing NCDs, with men having a higher risk, and
women who have reached menopause being more susceptible to heart attacks. Additionally,
women can be affected by NCD risk factors such as high blood pressure or high blood glucose
even during pregnancy.
Family history (genetics):Family hiatory also plays a significant role in NCD risk, with a higher
likelihood of developing NCDs if a close family member such as parents or siblings also have the
disease.

modifiable risk
factors
*unhealthy diet
*tobacco use
*alcohol consumption
*physical inactivity

Outcome
* Cardiovascular diseases
(Heart disease, Stroke)
*Diabetes
*Cancers
*Chronic Respiratory
Diseases (Asthma,
difficulty in breathing)

Non-Modifiable
Risk Factors
*Age
* Sex
*Family history

ii)Modifiable risk factor:

A behavioral risk factor that can be reduced or controlled by intervention, thereby reducing the
probability of disease.
WHO has prioritized the following four:
‒ Physical inactivity:
‒ Tobacco use,
‒ Alcohol use, and
‒ Unhealthy diets (increased fat and sodium, with low
fruit and vegetable intake).
iii)Metabolic risk factors:
These are responsible for four major metabolic changes that elevate the risk of NCDs. These
include;
- raised blood pressure,
- overweight/obesity,
-hyperglycemia or high blood glucose levels, and
- hyperlipidemia or high levels of fat in the blood.
The primary metabolic risk factor causing attributable deaths globally is elevated blood
pressure, which contributes to 19% of all global deaths, followed by raised blood glucose and
overweight/obesity.

Socioeconomic impact of non communicable disease

NCDs pose a threat to achieving the 2030 Agenda for Sustainable Development, which aims to
reduce the likelihood of death from the four main NCDs by one-third between ages 30 and 70.
Poverty and NCDs are closely intertwined, and the rapid increase of NCDs is predicted to hinder
poverty alleviation efforts in low-income countries. This is due, in part, to the rising household
costs associated with healthcare. People who are vulnerable and socially disadvantaged are
more likely to become ill and die prematurely than those in higher social positions. This is
largely due to their increased exposure to harmful products like tobacco and unhealthy dietary
practices, as well as their limited access to healthcare services.

Statistics of non communicable disease of last ten years

Key facts

Noncommunicable diseases (NCDs) kill 41 million people each year, equivalent to 74% of all
deaths globally.

 Each year, 17 million people die from a NCD before age 70; 86% of these premature
deaths occur in low- and middle-income countries.
 Of all NCD deaths, 77% are in low- and middle-income countries.
 Cardiovascular diseases account for most NCD deaths, or 17.9 million people annually,
followed by cancers (9.3 million), chronic respiratory diseases (4.1 million), and diabetes
(2.0 million including kidney disease deaths caused by diabetes).
 These four groups of diseases account for over 80% of all premature NCD deaths
 Top cause of death in Bangladesh(% of total)

Management and prevenetion of non communicable disease

year Stroke(%) Ishchemic heart Obstructive Diabetes Liver cirrhosis(%)

disease(%) pulmonary mellitus(%)
disease(%)

2010 88.28 57.02 29.85 15.3 14.09

2011 81.03 54.08 26.74 14.03 13.09

2012 75.26 52.65 23.95 13.22 12.09

2013 74.83 52.65 23.95 13.22 12.09

2014 76.37 54.56 24.75 13.92 11.95

2015 75.65 55.84 24.17 15.84 11.83

2016 76.38 57.36 24.89 14.68 12

2017 80.79 61.71 26.93 16.16 12.4

2018 81.95 64.48 27.64 17.08 12.7

2019 82.31 66.58 28.04 17.78 12.9

The global epidemic of NCDs is widely acknowledged as a major challenge to development in

the 21st century and is a significant threat to achieving the United Nations Sustainable
Development Goals. In addition, globally, the main NCDs represent the greatest cause of death
in people aged under 70 years, imposing years of disability on those affected and their families.
Noncommunicable diseases (NCDs) such as cardiovascular diseases (CVDs), diabetes, cancer
and chronic respiratory diseases (CRDs) are currently responsible for over 70% of global deaths.
This burden is one of the major public health challenges facing all countries, regardless of their
economic status. People with, or at risk of developing, NCDs require long-term care that is
proactive, patientcentered, community-based and sustainable. Such care can be delivered
equitably only through robust health systems founded on strong primary health care towards
the attainment of universal health coverage.
1.National policies, plans and resources for addressing major NCDs:
Enabling effective and equitable healthcare responses to the needs of people with non-
communicable diseases (NCDs) and establishing strong national policies and plans for their
prevention and control can help avoid most cases of premature mortality from NCDs.
Among the four main NCDs, cancer, diabetes, and cardiovascular diseases (CVDs) had more
broadly available and operational national policies and plans than chronic respiratory
diseases (CRDs) in high- and middle-income countries. In low-income countries, policies for
cancer were more widely available compared to other NCDs.
2. Evidence-based guidelines for NCD management
Evidence-based guidelines for the management of NCDs need to be developed and broadly
implemented to ensure appropriate diagnosis, referral and treatment. Globally, only 48% of
countries reported having evidence-based guidelines, protocols or standards for the
management of all four NCDs through a primary care approach. Guidelines for diabetes
were most widely available (84%), followed by CVDs (77%), cancer (70%) and CRDs (64%).
Correspondingly, countries were most likely to have guidelines for diabetes that included
referral criteria and were utilized in at least 50% of health care facilities, with 80% of
countries in upper-middle-income countries reporting having such guidelines
3. Availability of essential NCD technologies and medicines in primary health care
a. Essential technologies for NCDs
In order to manage non-communicable diseases (NCDs), a range of medical technologies is
necessary. However, in low-resource settings where there is limited investment in
healthcare, it can be difficult to choose the most cost-effective technologies. In order to
ensure equitable access to care, a prioritized set of technologies should be made available
in primary care based on the needs of the population. By combining these basic
technologies with trained healthcare personnel and referral systems, most patients with
major NCDs can be treated close to their homes, which will help to increase the utilization
of primary care services.
b. Essential medications for the treatment of NCDs
In 93% of high-income countries, compared to 10% of low-income, 20% of lower-middle-
income, and 57% of upper-middle-income nations, all 11 of the essential medications
surveyed (insulin, aspirin, metformin, thiazide diuretics, ACE inhibitors, angiotensin II
receptor blockers, calcium channel blockers, beta blockers, statins, steroid inhaler,
bronchodilator) were (Figure 6). In 90%, 87%, and 87% of countries, respectively, aspirin,
metformin, and thiazide diuretics were the most generally accessible necessary
medications. Less than two-thirds of countries worldwide (63%), with only 19% of low-
income and 33% of lower-middle-income countries reporting the typically availability,
reported having access to steroid inhalers.
4.Primary care services for NCDs
a. Cardiovascular risk assessment

One way to prevent and manage cardiovascular diseases (CVDs) in primary care is through
the use of cardiovascular risk prediction charts. These charts provide a comprehensive
approach to risk assessment and management, allowing healthcare resources to be directed
towards populations with the highest risk of developing heart attacks, strokes, and diabetes
complications. As of 2019, CVD risk stratification was offered in more than 50% of primary
healthcare facilities in 38% of countries globally. However, in low-income countries,
approximately 40% of health facilities did not offer CVD risk stratification.
b. Prevention and early detection of cancer
Cervical and liver cancers are two types of cancer that can be prevented through easily
accessible vaccinations. Unfortunately, 90% of cervical cancer deaths occur in low- and
lower-middle income countries, where access to healthcare services can be a challenge.
One of the three primary strategies for eliminating cervical cancer is to administer vaccines
for the most common types of human papillomavirus (HPV) that cause the disease. The
other two pillars are early screening and management of invasive cervical cancer through
diagnostic, treatment, and palliative care services.
5. Availability of specialized procedures and services
a.Treatment procedures for NCDs
To improve outcomes and reduce mortality rates, it is crucial that publicly funded health
systems offer accessible treatment services for NCDs in a timely manner. The survey
focused on key treatment procedures such as retinal photocoagulation, renal replacement
by dialysis or transplantation, coronary bypass, stenting, and thrombolytic therapy. These
procedures were readily available in more than 50% of high-income countries, but remained
scarce in low- and lower-middle-income countries.
b. Acute stroke care
The availability of acute stroke care also showed significant differences across countries. In
about one-third of low-income countries, only slightly more than 50% of patients in need of
acute stroke care could access it. This number increased to approximately 80% in high- and
upper-middle-income countries. Half of the lower-middle-income countries offered care to
patients in need.
6. Raising awareness among people
Non- Communicable diseases can be managed by maintaining following modifiable
factors:
1. Healthy Lifestyles
2. Healthy diet
3. Maintaining appropriate weight
4. Physical activity reduces the risk of cardiovascular diseases.
5. Quitting alcohol consuming
6. Stress management is a vital factor to reduce certain gastrointestinal problems
such as gastric ulcer and other psychiatric disorders.
7. Take proper caring of mental and physical health.
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