Epidemiology of Chronic Non-

communicable diseases
 Chronic Non-communicable diseases (NCDs)

Comprising all impairments or deviations from normal, which have one or more
of the following characteristics:
1. Are permanent
2. Leave residual disability
3. Are caused by non-reversible pathological alterations
4. Require special training of the patient for rehabilitation
5. May be expected to require a long period of supervision, observation or care

NCDs Include- cardiovascular, renal, nervous, mental diseases, musculoskeletal

conditions such as arthritis, allied diseases, chronic non-specific respiratory
diseases (chronic bronchitis, emphysema, asthma), permanent results of
accidents, senility, blindness, cancer, diabetes, obesity, and other metabolic
and degenerative diseases and chronic results of communicable diseases.
 Problem statement
Of the 57 million global deaths in 2008, 36 million or 63%,
were due to non-communicable diseases.
The four main NCDs are cardiovascular diseases, cancers,
diabetes and chronic lung diseases.

The leading causes of NCD deaths in 2008 were-

• cardiovascular diseases (17 million deaths, or 48% of all
NCD deaths),
• cancers (7.6 million, or 21% of all NCD deaths)
• respiratory diseases, including asthma and chronic
obstructive pulmonary disease (4.2 million).
• Diabetes caused another 1.3 million deaths.
1990

2020
 NCD burden in India
Total No. of deaths due to NCD per 100000 population

571
782 Males
Females
 Key factors
Key factors responsible for a NCDs morbidity and premature
mortality are:
1. Cigarette use and other forms of smoking
2. Alcohol abuse
3. Failure or inability to obtain preventive health services-
HT control, cancer detection & management of diabetes
4. Life-style changes- diet, physical activity
5. Environmental risk factors-occupational hazards,
pollution, destructive weapons
6. Stress factors
 NCDs- control & prevention
Challenges:
1. Absence of a known agent
2. Multifactorial causation
3. Long latent period
4. Indefinite onset

Prevention:
5. Mix of interventions (multifactorial)
6. Tertiary prevention- earlier days
7. Identification of risk factors- health promotion activities-
primary prevention
 Steps in prevention
1. Case finding –screening health examination technique
2. Application of improved methods of diagnosis, treatment and
rehabilitation
3. Control of food, water and air pollution
4. Reducing accidents
5. human behavioural and lifestyle changes
6. Intensive education
7. Upgrading standards of institutional care and
8. Developing and applying better methods of comprehensive
medical care including primary healthcare
9. Political approaches like ban on smoking, alcohol and drug abuse
Holistic approach-integrated approach
 Cardiovascular Diseases (CVD)
Group of diseases of the heart and the vascular system
which are-
• Coronary heart disease/Ischemic heart disease (IHD)-
disease of the blood vessels supplying the heart muscle
• Hypertension
• Cerebrovascular disease (Stroke)-disease of the blood
vessels supplying the brain
• Congenital heart disease- malformations of heart
structure existing at birth
• Rheumatic heart disease (RHD)- damage to the heart
muscle and heart valves from rheumatic fever, caused by
streptococcal bacteria
 Problem statement
• CVDs are the number one cause of death globally: more people die annually from CVDs than
from any other cause .
• An estimated 17.3 million people died from CVDs in 2008, representing 30% of all global
deaths. Of these deaths, an estimated 7.3 million were due to coronary heart disease and 6.2
million were due to stroke.
• Low- and middle-income countries are disproportionally affected: over 80% of CVD deaths
take place in low- and middle-income countries and occur almost equally in men and women.
• The number of people who die from CVDs, mainly from heart disease and stroke, will
increase to reach 23.3. million by 2030. CVDs are projected to remain the single leading cause
of death.

Risk factors:
1. Tobacco use
2. Inappropriate diet and
3. Physical inactivity
4. Biological factors
– Overweight
– Central obesity
– High blood pressure
– Dyslipidemia
– Diabetes
– Low cardio-respiratory fitness
Coronary heart disease (ischemic heart disease)
Impairment of heart function due to inadequate blood flow to
the heart compared to its needs, caused by obstructive
changes in the coronary circulation to the heart
25-30 % of deaths in most industrialized countries
WHO- Modern epidemic- a disease that affects populations,
not an unavoidable attribute of ageing.

Manifestation as:
1. Angina pectoris of effort
2. Myocardial infarction
3. Irregularities of the heart
4. Cardiac failure
5. Sudden death
 Measurement of burden of disease
1. Proportional mortality ratio
2. Loss of life expectancy
3. CHD incidence rate
4. Age-specific death rates
5. Prevalence rate
6. Case fatality rate
7. Measurement of risk factor levels
8. Medical care
 Risk factors/aetiology of CHD

Not modifiable Modifiable

• Age • Cigarette smoking

• sex • High blood pressure
• Family history • Elevated serum
• Genetic factors cholesterol
• Personality(?) • Diabetes
• Obesity
• Sedentary habits
• Stress
 Risk factors/aetiology
1. Smoking:
CO atherogenesis
Nicotine stimulation of adrenergic drive raising blood pressure & myocardial oxygen
demand
Lipid metabolism fall in protective high-density lipoproteins
No. of cigarettes
Filter cigarettes probably not protective
Smoking synergistic with hypertension and elevated serum cholesterol (more than
additive)

2. Hypertension:
HT accelerates atherosclerotic process

3. Serum cholesterol:
Triangular relationship between habitual diet, blood cholesterol, lipoprotein levels and CHD
Cholesterol/HDL ratio = <3.5 (goal for CHD prevention)

4. Other risk factors:

Diabetes, genetic factors, physical activity, hormones, type A personality, alcohol, oral
contraceptives, miscellaneous such as dietary fibre, sucrose, soft water
 Prevention of CHD

Population strategy Secondary

High risk strategy
Multifactorial Prevention
approach

Prevent recurrence &

Identifying risk Progression of CHD
Primordial
Prevention in whole Specific advice Drug trials, coronary
prevention in whole surgery, use of pace
population
population makers

Smoking cessation
Dietary changes Control of HT &
Traditional eating diabetes
Smoking cessation
pattern Healthy nutrition
Blood pressure
Life style practices Exercise promotion
Physical activity
 Risk factor Intervention Trials
Framingham Study- 1951, prospective study
study establishing the nature of CHD risk factors and their
relative importance-
Risk Factors Intervention

Elevated serum cholesterol Reduction of serum cholesterol

Smoking Cessation of smoking

Hypertension Control of hypertension

Sedentary lifestyle Promotion of physical activity

1. The Stanford three-community study

2. The North Kerelia Project
3. MRFIT (multiple risk factor intervention trial)
4. Oslow diet/smoking Intervention study
5. Lipid Research Clinics study
 Hypertension
• Hypertension (HTN) or high blood pressure is a
chronic medical condition in which the blood
pressure in the arteries is elevated. This requires the
heart to work harder than normal to circulate blood
through the blood vessels.
• Blood pressure is summarized by two
measurements, systolic and diastolic, which depend
on whether the heart muscle is contracting (systole)
or relaxed between beats (diastole) and equate to a
maximum and minimum pressure, respectively.
 Hypertension
• Chronic condition- role in the causation of CHD, stroke and other vascular
complications
• Major risk factor for Cardiovascular mortality (20-50% of all deaths)-public health
challenge
Category Systolic blood Diastolic blood
pressure mmHg pressure mmHg

Normal < 130 <85

High Normal 130-139 85-90
Hypertension
Stage 1 (mild) 140-159 90-99
Stage 2 (moderate) 160-179 100-109
Stage 3 (severe) > 180 > 110

Three Sources of error in recording blood pressure:

• Observer error
• Instrumental error
• Subject error
• What is New in Indian Guidelines on
Hypertension – 2013?

• Due to health related toxic effects of mercury,

mercury sphygmomanometers are being
replaced by aneroid and digital
sphygmomanometers.
 Classification of HT
1. Primary (essential)- causes are unknown (90%)
2. Secondary –some other disease process or abnormality is the cause
(10%)- kidney diseases, tumors of adrenal glands, congenital,
toxemias of pregnancy.

12
Rule of Halves:
1. The whole community 34
2. Normotensive subjects
3. Hypertensive subjects 56
4. Undiagnosed hypertension
78
5. Diagnosed hypertension
6. Diagnosed but untreated
7. Diagnosed and treated 9
8. Inadequately treated
9. Adequately treated
 Risk factors for HT

Non-modifiable risk factors Modifiable risk factors

• Age • Obesity
• Sex • Salt intake
• Genetic factors • Saturated fat
• Ethnicity • Dietary fibre
• Alcohol
• Physical activity
• Environmental stress
• Socio-economic status
• Other factors
 Prevention of HT

Primary Secondary

Early case detection

Population strategy High-risk strategy
Treatment
Patient compliance

Nutrition (DASH diet-

Dietary Approaches to
Stop HTN) Detection of high-
Weight reduction risk subjects
Exercise promotion Childhood BP
Behavioural changes monitoring
Health education
Self-care
 Stroke (apoplexy)
Acute severe manifestations of cerebrovascular disease.
Causes both physical and mental crippling.
“Rapidly developed clinical signs of focal disturbance of cerebral function
lasting more than 24 hours or leading to death with no apparent cause other
than vascular origin”.

Morphological abnormalities:
Stenosis, occlusion or rupture of arteries

Symptoms:
Coma, hemiplegia, paraplegia, monoplegia, multiple paralysis, speech disturbances, nerve
paresis, sensory impairment.

Stroke includes:
• Subarachnoid haemorrhage
• Cerebral haemorrhage
• Cerebral thrombosis or embolism
• Occlusion of pre-cerebral arteries
• TIA (>24 hours)
• Ill-defined cardiovascular disease
 Stroke control programme
1. Control of arterial hypertension
2. Control of diabetes,
3. elimination of smoking
4. Prevention, management of other risk factors
5. Primary prevention through community
health action.
 Rheumatic Heart Disease (RHD)
• Rheumatic fever- febrile disease affecting
connective tissues esply., in the heart and joints
initiated by infection of the throat by group A
beta hemolytic streptococci.
• Though it is not a communicable disease but it
results from a communicable disease
(streptococcal Pharyngitis)
• Rheumatic fever RHD (crippling disease)-
continuing damage to the heart, increasing
disabilities, repeated hospitalization, premature
death (<35 years)
 Problem statement

• 1994- 12 million individuals suffered from RF and RHD

worldwide
• In 2002- estimated no. of death from RHD worldwide was
327000 (0.6% of total deaths due to CVD)
• In India- 5-7 per thousand in 5-15 years age group there are
about 1 million RHD cases in India.

• Jai Vigyan Mission mode Project on community control of

RF/RHD in India four main components:
– Study epidemiology of streptococcal sore throats,
– establish registries for RF and RHD,
– Vaccine development for Streptococcal infection
– conducting advanced studies on pathological aspects of RF and RHD.
 Epidemiological factors
1. Agent factor:
Agent: preceded by streptococcal sore throat

2. Host factors:
Age: Childhood 5-15 years (juvenile mitral stenosis)
Sex: affects both sexes equally
Socio-economic status: poverty, overcrowding, poor housing
conditions, inadequate health services, inadequate expertise
of healthcare providers , low level of awareness of the
disease
High-risk groups: school-age children (5-15 years), slum dwellers,
closed community groups
 Prevention
1. Primary prevention: Identification of sore throat patients
(children) with streptococcal infection and treating them
with penicillin, target group- 5-15 years treated as High-risk
groups and kept under surveillance for streptococcal
pharyngitis, throat swab of all sore throat cases and treat
with penicillin or erythromycin
2. Secondary prevention: in developing countries identifying
those who have had RF and giving them one IM injection of
benzathine benzyl penicillin at intervals of 3 weeks
continued for 5 years and until the child reaches 18 years of
age (long-term)
3. Non-medical measures: improving living conditions, breaking
the poverty-disease-poverty cycle.
 Cancer
Group of diseases characterized by:
• Abnormal growth of cells
• Ability to invade adjacent tissues and even distant organs
• Eventual death of the affected patient if the tumor has progressed
beyond that stage when it can be successfully removed.

Categories:
1. Carcinomas- arising from epithelial cells
2. Sarcomas-arising from mesodermal cells (connective tissue)
3. Lymphomas-arising from cells of bone marrow and immune system

Types:
1. Primary tumor-cancer in the organ of origin
2. Secondary tumor- cancer that has spread to regional lymph nodes
and distant organs.
 Problem statement
• Affects all communities in the world
• 10 million people are diagnosed with cancer
• > 6 million die of cancer disease every year

Most common cancers (incidence):

– Lung cancers (12.3%)-1.1 million deaths annually
– Breast cancer (10.4%)
– Colorectal cancer (9.4%)

Top three causes of death from cancer:

Cancers of Lung, stomach, liver
India:
National Cancer Registry Programme of ICMR provides data on
incidence from five population-based registries and one rural-based
population registry
Approx. 2-2.5 million cases of cancer at any given point of time
7-9 lakh new cases detected every year
Male: 3.9 lakh, female: 4.3 lakh

Occurrence of cancer in males and females:

Male: Mouth/oropharynx, oesophagus, stomach and lower respiratory
tract
Female: cervix, breast, mouth/oropharynx and oesophagus
 Time trends & Cancer patterns
• Today cancer is the second leading cause of death in
industrialized countries as-
Longer life expectancy, more accurate diagnosis and rise in
cigarette smoking.

Wide variation in cancer distribution throughout the world:

• Japan-stomach cancer, US- less
• Columbia-cervical cancer, Japan-low
• SEAR- cancers of oral cavity and uterine cervix

Reasons: environmental factors, food habits, life style changes,

genetic factors or efficiency of detection and reporting.
 Causes of Cancer
1. Environmental factors:
Tobacco- smoking-lung cancer, larynx, mouth, pharynx, oesophagus,
bladder, pancreas, kidney
Alcohol- oesophageal and liver cancer
Dietary factors- smoked fish-stomach cancer, etc.
Occupational exposures-benzene, cadmium, chromium, arsenic
Viruses- hepatitis A and B, CMV, HPV, EBV
Parasites-schistosomiasis causing bladder cancer
Customs, habits and life-styles
Others-sunlight, radiation, air and water pollution

2. Genetic factors:
Mongols – leukaemia common
 Cancer Control
Cancer Control

Primary Prevention Secondary Prevention

Control of tobacco,
alcohol consumption
Personal hygiene
Cancer Registration-
Radiation
Hospital based
Occupational exposures
Registries,
Immunization
Population based
Foods, drugs and
Registries
cosmetics
Early detection of
Air pollution
cases
Treatment of
Treatment
precancerous lesions
Legislations
Cancer education
 Cancer Screening
• Search for unrecognized malignancy by means of rapidly applied tests
• Three purpose:
1. Malignant disease is preceded for a period of months or years by a
premalignant lesion, removal of which prevents subsequent
development of cancer
2. Most cancers begin as localized lesions and if found at this stage a
high rate of cure is obtainable
3. As much as 75% of all cancers occur in body sites that are accessible.

Methods of cancer screening:

4. Mass screening by comprehensive cancer detection examination
5. Mass screening at singe sites such as uterine cervix, breast or lung
6. Selective screening –high-risk group at periodic intervals

Screening for cancer cervix, breast cancer and lung cancer done
routinely.
 Oral Cancer
• One of the ten most common cancer in the world.
• India Males: 12.48 females: 5.52 per 100000

Causes:
1. Tobacco
2. Alcohol
3. Pre-cancerous stage
4. High-risk groups-tobacco chewers, smokers, bidi smokers, people using tobacco
in other forms such as betel quid, and sleeping with tobacco quid in the mouth
5. Cultural patterns: smoking (bidi, chutta, hookah, snuff inhalation, reverse
smoking of cigar.
Prevention:
Primary- habit elimination through health education and motivation for lifestyle
changes supported by legislative measures.
Secondary- early detection (primary health workers especially village guides and
multi-purpose workers), surgery and radiotherapy.
 Cancer of the cervix
• Second most common cancer among women worldwide 524000 new cases in 1995.
• Developing countries- 80% of cases
Normal epithelium dysplasia cancer in situ invasive cancer
HPV possible cause through sexual transmission

Risk factors:
1. Age: 25 to 45 years of female
2. Genital warts: possible earlier warts predisposing factor
3. Marital status: widowed, divorced, multiple sexual partners
4. Early marriage
5. Oral contraceptive pills
6. Socio-economic status: common in lower strata of the society

Prevention and control:

Primary prevention- improved personal hygiene, birth control
Secondary prevention- early detection and treatment by radical surgery and
radiotherapy
 Breast Cancer
One of the commonest causes of cancer in women

Risk factors:
1. Age: 35-50 years of age
2. Family history: greater chances if positive family history
3. Parity: age at women bear the first child, marital status, no. of children, etc.
4. Age at menarche and menopause
5. Hormonal factors: elevated estrogen and progesterone high risk
6. Prior Breast biopsy: increases risk
7. Diet: high fat diet and obesity
8. Socio-economic status: common in higher socio-economic groups
9. Others: radiation, oral contraceptives, etc.

Prevention:
Primary prevention- elimination of risk factors, strenuous physical activity, reducing
fat intake.
Secondary Prevention: Breast screening, early diagnosis, follow-up,
 Lung Cancer
• Industrial workers more prevalent
• Cigarette smoking
• 6.8 % of all malignancies in India
Age: <65 years

Risk factors:
1. Smoking
2. Other factors: air pollution, radioactivity, occupational exposure to asbestos, arsenic
chromates, particles containing polycyclic aromatic hydrocarbons and nickel-bearing
dusts.
Prevention:
Primary Prevention-
Public information and education
Legislative and restrictive measures
Smoking cessation activities
National and international coordination
Secondary Prevention-
Early detection of cases, proper treatment
Chest x-ray and sputum cytology
 Stomach Cancer
World’s second most common cancer with over
1 million new cases every year.
High-risk areas include- Central and South
America and Eastern Asia and also Japan
Decreasing incidence attributed to:
Improved food preservation practices, better
nutrition more rich in vitamins from fresh
vegetables and fruits, less consumption of
preserved, cured and salted foods.
H.Pylori contributes to the risk
 Diabetes Mellitus
• Not a single disease but heterogeneous group of diseases characterised by state
of chronic hyperglycemia, resulting from a diversity of aetiologies, environmental
and genetic, acting jointly.
• Underlying cause: defective production or action of insulin (hormone controlling
glucose, fat and amino acid metabolism)
• Long-term disease with variable clinical manifestations and progression
• Leads to cardiovascular, renal, neurological ocular and others such as
intercurrent infections.

Classification of DM:
1. Diabetes mellitus
• Insulin dependent DM (IDDM type I)
• Non-insulin dependent DM (NIDDM type II)
• Malnutrition-related DM (MRDM)
• Other types (secondary to pancreatic, hormonal, drug-induced, genetic and other
abnormalities
2. Impaired Glucose tolerance (IGT)
3. Gestational diabetes mellitus (GDM)
 Problem statement
• Diabetes is an iceberg disease
• 150 million cases of diabetes worldwide
• Predicted to be doubled by 2025 with greatest no.
in China and India
• Previously disease of middle aged and elderly but
now all age groups –productive period of lives,
burden, economic implications, cost of treatment,
life expectancy, chronic complications of DM
• Associated with industrialization and socio-
economic development-population growth, age
structure, urbanization.
 Epidemiological factors
Agent: insulin deficiency-
1. Pancreatic disorders-inflammatory, neoplastic and others such as cystic
fibrosis
2. Defects in the formation of insulin
3. Destruction of beta cells-viral infections, chemical agents
4. Decreased insulin sensitivity,
5. Genetic defects
6. Auto-immunity

Host factors:
Age: any age, NIDDM –middle age
Sex: varies with countries
Genetic factors: strong genetic component
Immune mechanism:
Obesity: central adiposity, increased BMI
Maternal diabetes
 Epidemiological factors
Environmental risk factors:
1. Sedentary lifestyle
2. Diet-high saturated fat intake
3. Dietary fibre- intake reduces incidence of DM
4. Malnutrition-PEM in early infancy and childhood leads to
failure of Beta cell function
5. Alcohol
6. Viral infections- rubella, mumps, human coxsackie virus B4
7. Chemical agents: alloxan, streptozotocin, VALCOR,etc.
8. Stress-surgery, trauma, stress of situations, internal or
external
9. Other factors: social factors, etc.
 Prevention and control
Screening for diabetes:
Urine examination
Blood sugar testing,
Target population-high-risk group->40 years, f/h of diabetes, obese,
women, patients with premature atherosclerosis

Prevention and care:

1. Primary Prevention:
Population strategy
High-risk group
2. Secondary prevention-monitoring of blood glucose levels in diagnosed
cases, maintain ideal body weight, diet and oral antidiabetic agents,
diet and insulin.
3. Tertiary Prevention-specialized clinics (diabetic clinics) to treat and
manage the complications of diabetes – kidney failure, blindness,
coronary thrombosis, gangrene of lower extremities, etc.
 Obesity
Defined as an abnormal growth of the adipose tissue due to an enlargement of fat cell
size or increase in fat cell number or combination of both.
Most prevalent form of malnutrition
Chronic disease affecting children and adults, significant contributor to illhealth
Epidemiological determinants:
1. Age
2. Sex: women have higher rate of obesity than men
3. Genetic factors:
4. Physical inactivity
5. Socio-economic status
6. Eating habits
7. Psychosocial factors
8. Familial tendency
9. Endocrine factors
10.Alcohol
11.Education
12.Smoking
13.Ethnicity
14.drugs
 Obesity
Measured using Body Mass Index (BMI)- weight in kg divided by
square of the height in metres (kg/m2)
Criteria;
Body weight
Skinfold thickness
Waist circumference and waist:hip ratio
Others: total body water, total body potassium and body density
Hazards: Increased morbidity and mortality

Prevention and control:

– Weight control
– Dietary changes, increased physical activity, others such as surgical,
education.
 Blindness
• Visual acuity of less than 3/60 (Snellen) or its equivalent or inability to
count fingers in daylight at a distance of 3 meters to indicate less than
3/60 or its equivalent.
• WHO ICD describes levels of visual impairment as low vision and
blindness.
• Estimated 180 million people worldwide are visually disabled, of whom
nearly 45 million are blind, four out of five living in developing countries.
• About 80% of blindness is avoidable (treatable or potentially preventable)
• Reduced economic and social status but may also lead to premature
death.
• Major causes:
– Cataract (19 million)
– Glaucoma (6.4 million)
– Trachoma (5.6 million)
– Childhood blindness (>1.5 million)
– Onchocerciasis (0.29 million) and others (10 million)
 Problem statement
• Prevalence- 0.2 % or < in developed and > 1% in developing countries
• SEAR: 1/3rd of world’s blind (15 million) and 50% of world’s blind children (0.7
million) live in this region.
• 45 million people with impaired vision and low vision.

India:
Annual incidence of 2 million cataract induced blindness
3 million eyes need cornea transplantation
Prevalence of blindness in population 50 years and above to be about 8.5 % and
general population about 1.1 %.

Causes of blindness:
Developed countries: Accidents, glaucoma, diabetes, vascular diseases, cataract and
degeneration of ocular tissues (retina, hereditary conditions)
SEAR: Cataract, Vit A deficiency, glaucoma, age-related macular degeneration, diabetic
retinopathy, corneal ulcer and ocular trauma.
Childhood blindness: xerophthalmia, congenital cataract, congenital glaucoma and
optic atrophy due to meningitis, retinopathy of prematurity, uncorrected refractive
errors.
 Epidemiological determinants
1. Age: 30 % of blind in India are said to lose their eyesight before they
reach the age of 20 years and < 5 years of age.
2. Children: Refractive errors, trachoma, conjunctivitis, malnutrition
3. Young age group: cataract, refractive errors, glaucoma and diabetes
4. Accidents and injuries-all age groups
5. Sex: higher prevalence in females than males.
6. Malnutrition: Vit. A deficiency, PEM
7. Occupation: workers in industries exposed to dust, injuries, gases,
fumes, flying objects, radiation (welding flash), electrical flash.
8. Social class: More prevalent in low socio-economic class
9. Social factors: quacks, ignorance, poverty, low standard community
and personal hygiene, inadequate health services.
 Concepts in eye care
1. Primary eye care: inclusion of eye care in primary health care
2. Epidemiological approach: studies at population level-incidence, prevalence and risk factors
3. Team concept: eye specialist and auxiliary health personnel, health guides, ophthalmic assistants, multi-
purpose workers, voluntary agencies.
4. Establishment of national programmes: National programme for the control of blindness-goal was to reduce
blindness in the country to 0.3 percent by year 2000.

Components of National programme:

1) Initial assessment
2) Methods of intervention
– Primary eye care
– Secondary care
– Tertiary care
– Specific programmes
• Trachoma control
• School eye health services
• Vitamin A prophylaxis
• Occupational eye health services
3) Long-term measures
4) Evaluation

National and international agencies: National Association for the Blind (NAB), Royal Commonwealth Society for
the Blind, International Agency for prevention of blindness

National Programme for the Control of Blindness

 Accidents and Injuries
• Accident: an unexpected, unplanned occurrence which may involve
injury.
• Unpremeditated event resulting in recognizable damage
• Occurrence in a sequence of events which usually produces
unintended injury, death or property damage.
• Major epidemic of NCDs-part of price we pay for technological
progress.
• Accidents have their own natural history and follow the same
epidemiological pattern-agent, host and environment interacting to
produce injury or damage.
• Certain age groups, certain times of day, week and certain localities
• Some people are more prone to accidents, increased by effect of
alcohol, and other drugs, fatigue
• Majority of accidents are preventable.
 Problem statement
• Measurements of the problem:
1. Mortality:
– Proportional mortality rate
– No. of deaths per million population: the term killed
– Death rate per 1000 registered vehicles per year.
– No. of accidents or fatalities as a ration of the no. of
vehicles per KM or passengers per KM
– Deaths of vehicle occupants per 1000 vehicles per year.
2. Morbidity: seriousness of the injury is assessed by a
scale known as Abbreviated Injury Scale
3. Disability: outcome of
accident-temporary/permanent, partial or total
 Problem
1990s- RT injuries ranked ninth among the leading causes of deaths in
the world.
Projected to become second leading cause by the year 2020 next to IHDs
Injuries are responsible for 9.1 % (5.16 million) of all deaths in the world
and 16% of disabilities are due to injuries.
About 3.5 million people die of unintentional injuries and about 1.6
million die of intentional injuries. RTAs claim 1.2 million lives
Injuries due to road traffic, occupational accidents, burns, poisoning,
suicides and violence –major cause for mortality and morbidity.

India: accidents are on an increase in India

Increasing mechanization in agriculture and industry, induction of semi
skilled and unskilled workers in various operations and rapid increase
in vehicular traffic. Overcrowding, lack of awareness, poor
implementation of essential safety precautions, consumption of
poisonous substances,
 Types of Accidents
1. Road Traffic Accidents- pedestrians, animals collision with
vehicles, old and poorly maintained vehicles, large no. of
motorcycles, scooters, low driving standards, large no. of
buses often overloaded, disregard of traffic rules, defective
road, poor street lighting, defective layout of cross roads
and speed breakers, unusual behaviour of men and animals.
2. Domestic Accidents- drowning, burns, poisoning, falls,
injuries from sharp or pointed instruments, bites and other
injuries from animals
3. Industrial Accidents- man machine interface, physically and
mentally challenged
4. Railway accidents
5. Violence- intentional injuries
 Human factors Multiple causation
Age
Sex
Education
Medical conditions- sudden
illness, heart attack,
impaired vision
Fatigue
Psychosocial factors-
experience, risk taking,
impulsiveness, defective
judgment, delay in
decision, aggressiveness,
poor perception, family
dysfunction
Lack of body protection
vulnerability and or
Precipitating factors
Heightened
emotional tension,
alcohol and drugs
Environmental
factors
• Relating to road-
defective narrow roads,
defective layout, poor
lighting, speed breakers,
lack of familiarity,
• relating to vehicle-
excessive speed, old
poorly maintained
vehicle, overloaded, low
driving standards,
• Bad weather-
inadequate
enforcement of laws,
mixed traffic
Increased
Precipitating factors
risk situation Special traffic
conditions, social
pressure, use of
Accident stolen vehicles
 Prevention and control measures
Prevention and control measures:
1. Data collection
2. Safety education
3. Promotion of safety measures
4. Alcohol and other drugs
5. Primary care
6. Elimination of causative factors
7. Enforcement of laws
8. Rehabilitation services
9. Accident research- accidentology