BY: Dr.

Nebiyu simegnew
NON-COMMUNICABLE DISEASES

Lidetu Ababa
Tefera Bala
Moderator: Mr. Mohamed
05/12/2023 NCD 1
 Outline
o Definition of Non-communicable Diseases
o Epidemiological transition of diseases
o Global and local burden/trend of non-communicable diseases
o Risk factors of non-communicable diseases
o Myths and facts of non-communicable diseases
o Prevention and control of non-communicable diseases
o Policy and strategy of NCDs in Ethiopia

05/12/2023 NCD 2
 Objective
At the end of this presentation, you will be able

oTo define of Non-communicable Diseases

oTo identify the epidemiological transition of diseases
oTo know Global and local burden/trend of non-
communicable diseases
oIdentify the Risk factors of non-communicable diseases
o Know Myths and facts of non-communicable diseases
oKnow Prevention and control method of non-communicable
diseases
oKnow Policy and strategy of NCDs in Ethiopia

05/12/2023 NCD 3
 Non communicable disease

o A non-communicable disease is a disease that is NOT transmitted by

another person, a vector, or the environment

o Is a disease that has a prolonged course, that does not resolve

spontaneously, and for which a complete cure is rarely achieved

o The terms non-communicable, chronic and degenerative diseases are

used interchangeably in many literatures.

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 …NCD
o Non-communicable diseases are generally characterized by :
Long latency period
Prolonged course of illness with unlikelihood of cure
Non-contagious origin
 Functional impairment/disability and
Complex causality

05/12/2023 NCD 5
 Epidemiologic transitions
o Epidemiologic transition refers to the process by which the pattern of morbidity and
mortality in a population is transformed.

o It is a theory that describe changing pattern of population in age distribution, mortality,

fertility, life expectancy or cause of death.

o Initially this process was thought to be unidirectional , however it become apparent that
it is complex and dynamic

05/12/2023 NCD 6
 Stages of epidemiologic transition

o First stage: Age of pestilence and famine

o Second stage: Age of receding pandemics

o Third stage: Age of degenerative, stress, and man-made diseases

o Fourth stage: Age of declining cardiovascular mortality, ageing, lifestyles

modification, emerging and resurgent diseases

o Fifth stage(Futuristic stage): Age of aspired quality of life, with paradoxical

longevity and (futuristic stage) persistent inequities.
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 The First stage: Age of pestilence and famine

o started when hunter gatherers began to practice agriculture and began to live in one place.

o It continued in the West until, the late 18th but continued until the middle decades of the
20th century in the Third World

o This shift led to zoonotic disease, nutrient deficiencies, and increased contact with disease
vectors during agricultural activities.

o There was a transition from few epidemics to major epidemics and problem with nutrition.

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 …The First stage
o This is a stage of high mortality, high fertility, and slow or cyclic
population growth

o Life expectancy was short, oscillating between 20 and 30+ years

o Health care was provided by indigenous systems that relied on herbal

remedies, barber surgery, cautery, blood letting, bone setting, and
sometimes witchcraft

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 The Second stage: Age of receding pandemics

o This stage was delayed until the 1940s or 1950s in third world

o It marks the early relief from the devastating epidemics that could be
transmitted from one country to another

o Early in this stage, mortality remained at a high level, but began to

decline late the 18th in some country

o Life expectancy at birth increased to 40 to 50 years

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 …The Second stage
o Generally it was a time where:
 Human immune systems and disease -causing organisms both
evolved

 People developed physical and genetic changes that serve to

minimize the effects of diseases.

 There was a transition from major epidemics of disease to endemic

diseases.

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The Third stage: Age of degenerative, stress, and manmade
diseases
o It has been taking place since the 1970s in non-western countries

o This stage is a manifestation of the increasing prevalence of

Heart diseases
Cerebrovascular accidents (strokes)
Cancer at various sites
Diabetes
Chronic obstructive pulmonary disease and
Metabolic disorders
Man-made diseases

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 …The Third stage

o The third transition became from improved public health and

sanitation.

o In the West, life expectancy at birth rose gradually from about 50 to

75 years or more

o It is Age of triple health burden in non-western societies

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 …The third stage

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 The Fourth stage:
o It started at the end of the 20th century in western

o It was due to increased globalization.

o It is age of declining cardiovascular mortality, ageing, lifestyles modification,

emerging and resurgent diseases

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 …The Fourth stage

o This stage is characterized by

Further increases in life
expectancy which approach to 80
to 85 years
Decline of cardiovascular
mortality
Emergence of both new diseases
and the reemergence of infectious
disease

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 Global burden of NCD
o Non communicable diseases are the leading cause of death globally, and one of the
major health challenges of the 21st century

o In 2016, it was responsible for 71% of the 57 million deaths which occurred globally
and it increased to 74.5% in 2019

o Suicide responsible for about 1.4%(800000) of all death

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 …Global burden

o The major NCDs responsible for these deaths included

Cardiovascular diseases accounting for 44% of all NCD deaths
Cancers accounting for 22% of all NCD deaths
Chronic respiratory diseases accounting for 9% of all NCD deaths
Diabetes accounting for 4% of all NCD deaths

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 …Global burden

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 …Global burden
o A clear relationship is evident between premature NCD mortality and
country income levels.
 In 2016, 78% of all NCD deaths, and 85% of premature adult NCD deaths,
occurred in low- and middle-income countries

Adults in low and lower-middle-income countries faced the highest risk of

dying from an NCD, 21% and 23% respectively

Almost double the rate for adults in high-income countries, 12%.

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 …Global burden
o Proportion of NCD deaths occurring among those aged 30 - 69 years,
by income group, 2016

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 Burden of NCD in Ethiopia

o Available evidences show Ethiopia is in epidemiologic transition.

o Triple burden of disease is already emerging with the mix of persistent

 Infectious diseases
 Increasing non-communicable diseases and
 Injuries

o NCD Country Profiles 2018 Report by the WHO indicated there were a
total of 700,000 deaths in Ethiopia in 2016

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 …NCD in Ethiopia

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 Major NCD
Cardiovascular Diseases
Diabetes Mellitus
Cancer
Chronic respiratory disease

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Cardiovascular Diseases

o Cardiovascular disease is a collection of diseases and conditions, which

consists of the heart and all the blood vessels throughout body.

o CVD has two main components:

Cardio and
 Vascular .
o It can be congenital or acquired
o Some types of cardiovascular disease can even cause other types of
cardiovascular disease.

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Types of Cardiovascular Disease

o Coronary heart disease (CHD, ischemic heart disease, heart attack, myocardial infarction, angina
pectoris)
o Cerebrovascular disease (stroke, TIA (transient ischemic attack))
o Hypertensive heart disease
o Peripheral vascular disease
o Heart failure
o Rheumatic heart disease (streptococcal infection)
o Congenital heart disease
o Cardiomyopathies

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 Classification of risk factors
I. Major modifiable risk factors
o High B/P
o Abnormal blood lipid
o Tobacco use
o Physical inactivity
o Obesity
o Unhealthy diet
o DM

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 …Classification of risk factors

II) Other modifiable risk factors

o Low socioeconomic status
o Mental ill health (depression)
o Psychosocial stress
o Heavy alcohol use
o Use of certain medication
o Lipoprotein
III) Non modifiable risk factors
o Age
o Heredity or family history
o Sex
o Ethnicity or race

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 Prevention& control strategies

Primary:
o Controlling risk factors contributing to CVD like:
 health education programs

 anti-smoking campaign

 sports programs

 nutrition counselling

 regular check of blood pressure and certain blood parameters,

e.g., cholesterol, blood lipids, glucose

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 Prevention& control…
Secondary:
 Screening and treatment of symptomatic patients, set up personal risk
profile, risk management
 Medical Rx (clot-dissolving medication , beta blockers…)
Tertiary:
 Cardiovascular rehabilitation, prevention of recurrence of CVD (new
heart attack: 5-7 times higher risk among CVD patients) ,risk
reduction, promote recovery, ongoing mgt ,exercise , weight mgt,
stress mgt, reduce excessive alcohol …

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 Diabetes Mellitus
o DM is a chronic condition that occurs when the pancreas does not
produce enough insulin or when the body cannot effectively use the
insulin it produces

o There are two basic forms of diabetes:

 Type 1: people with this type of diabetes produce very little or no
insulin.
 Type 2: people with this type of diabetes cannot use insulin
effectively.
 Most people with diabetes have type 2.

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 RISK FACTORS
Type I
 Family history
 Environmental risk factors ( dietary, infection like entero virus, rotavirus,
rubella) , chemicals & toxins for w/c the result is inconclusive
Type II
 Obesity
 Physically inactive
 Ethnicity ( reported in people of Asian & African origin, indigenous people
of America & Australia)

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 RISK FACTORS…

o Diabetes in utero increases the risk of developing type 2 diabetes in

early adulthood

o Disproportionate growth and low birth weight increase the risk of

developing diabetes and insulin resistance

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 THE URGENT NEED FOR PREVENTION OF DIABETES AND
ITS COMPLICATIONS
o The prevention of type 1 diabetes remains an objective for the future.
o However, simple lifestyle measures have been shown to be effective in preventing or
delaying the onset of type 2 diabetes. This includes:
 Increased physical activity
 A healthy diet
 Weight control
 Non-smoking

NCD 34
05/12/2023
PREVENTION OF DIABETES…

 Primary prevention protects susceptible individuals from developing

diabetes.

 Secondary prevention includes early detection and treatment.

 Appropriate action taken at the right time is beneficial in terms of

quality of life, and is cost-effective, especially if it can prevent
hospital admission

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 Cancer
o Cancer is the uncontrolled growth and spread of cells that arises from a
change in one single cell.

o The change may be started by external agents and inherited genetic factors
and can affect almost any part of the body.

o The transformation from a normal cell into a tumor cell is a multistage

process where growths often invade surrounding tissue and can metastasize
to distant sites.

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 Cancer…
o The majority of cancer death resulted from Lung, breast, colorectal, stomach
and liver cancers

o In high-income countries, the leading causes of cancer deaths are lung cancer
among men and breast cancer among women.

o In low- and middle-income countries cancer levels vary according to the

prevailing underlying risks.

o In sub-Saharan Africa, for example, cervical cancer is the leading cause of cancer
death among women.
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 Cancer:
Risk factors for cancer
o Tobacco use
o Unhealthy diet
o Insufficient physical activity
o Harmful use of alcohol
o Infections (hepatitis B, hepatitis C (liver cancer), human papillomavirus
(HPV; cervical cancer), Helicobacter pylori (stomach cancer)
o Radiation
o Variety of environmental and occupational exposures of varying
importance

05/12/2023 NCD 38
 Cancer:

WHO’s approach to cancer has four pillars:

Prevention
Early detection
Screening
Treatment
Palliative care.

05/12/2023 NCD 39
 Cancer:

o At least one third of the 10 million new cases of cancer each year are
preventable through reducing tobacco and alcohol use, moderating diet and
immunizing against viral hepatitis B.

o Early detection and prompt treatment where resources allow can reduce
incidence by a further one third.

o Effective techniques are sufficiently well established to permit

comprehensive palliative care for the remaining more advanced cases.

05/12/2023 NCD 40
 Cancer…
National cancer control program
o WHO has consolidated tools called national cancer control program, which
focuses government attention and services on all facets of the fight.

o National cancer control program is a public health program designed

• To reduce cancer incidence and mortality and improve cancer patients’ quality of life, through
the
• Use systematic and equitable implementation of evidence-based strategies
• Aims at prevention, early detection, diagnosis, treatment and palliation, making the best use
of available resources.

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 Chronic respiratory diseases

o According to the WHO Global Status Report on NCDs 2010, smoking is estimated
to cause about 71% of all lung cancer deaths and 42% of chronic respiratory
disease worldwide.
o Of the six WHO regions, the highest overall prevalence for smoking in 2008 was
estimated to be in the European Region, at nearly 29%.

05/12/2023 NCD 42
 Chronic respiratory diseases…

o Survey data from 2002–2007 indicate that over half of all children
aged 13–15 years in many countries in the European Region are
exposed to second-hand tobacco smoke at home.

o Second-hand smoke causes severe respiratory health problems in

children, such as asthma and reduced lung function; and asthma is
now the most common chronic disease among children throughout the
Region. 

43
05/12/2023 NCD 43
Chronic respiratory diseases…

o Indoor air pollution from biological agents related to damp and mould
increases the risk of respiratory disease in children and adults.

o Children are particularly susceptible to the health effects of damp,

which include respiratory disorders such as irritation of the respiratory
tract, allergies and exacerbation of asthma.

o Damp is often associated with poor housing and social conditions,

poor indoor air quality and inadequate housing hygiene.

05/12/2023 NCD 44
 Chronic respiratory diseases…

Ozone pollution causes

o Breathing difficulties,
o Triggers asthma symptoms,
o Causes lung and heart diseases, and
o Associated with about 21 000 premature deaths per year in 25
countries in the WHO European Region.

05/12/2023 NCD 45
 Current status and trends in risk factors
Major modifiable risk factors Other modifiable risk factors
- High blood pressure - Low socioeconomic status
- Tobacco use - Mental ill health (depression)
- Physical inactivity - Psychosocial stress
- Obesity - Use of certain medication
- Unhealthy diet - Lipoprotein(a)
- Heavy alcohol use - Abnormal blood lipids
- Raised blood sugar

Non-modifiable risk factors ”Novel” risk factors

- Age - Excess homocysteine in blood
- Heredity or family history - Inflammatory markers (CRP)
- Gender - Abnormal blood coagulation (elevated blood levels
- Ethnicity or race of fibrinogen)

05/12/2023 NCD 46
 …trends in risk factors
o In turn, these behaviors lead to four
key metabolic/physiological changes:
Raised blood pressure,
Overweight/obesity,
Raised blood glucose, and
Raised blood lipids.

o Environmental air pollution is also a

key risk factors

05/12/2023 NCD 47
 Harmful use of alcohol

o The harmful use of alcohol is a major risk factor for

Premature deaths and disabilities in the world,
Heart diseases,
Cancers, liver diseases,
Range of mental and behavioral disorders, and
Other non-communicable conditions

o In 2016, the level of alcohol consumption worldwide was 6.4 liters of

pure alcohol per person aged 15 years or older

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 Physical inactivity
o Drives the increasing magnitude
of NCDs.

o 30 minutes of moderate-
intensity physical activity is
valuable
o Physical activity lowers the risk
of
Stroke,
Hypertension and
Depression
05/12/2023 NCD 49
 …Physical inactivity

o In 2018, WHO launched a global action plan

To promote physical activity,
To provide updated guidance to countries and
Promote a framework of effective and feasible policy actions to increase
physical activity at all levels

• Globally in 2016, 28% of all adults aged 18 years and older were
insufficiently physically active

05/12/2023 NCD 50
 …Physical inactivity
o High-income countries had more than double the prevalence of
physical inactivity (37%) than low-income countries (16%)

o Globally, levels of physical inactivity have not decreased in the past 15

years (29% in 2001; 28% in 2016) and currently, the world is not on
track to meet the global 2025 target for reduced physical inactivity

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 Salt/sodium intake
• Consuming a diet high in salt contributes to raised blood pressure and increases
the risk of heart disease and stroke.

• To reduce the risk, the recommended daily intake of sodium is less than 2 grams of
sodium or 5 grams of salt.

• The global NCD targets include a sodium reduction target of a 30% relative
reduction in mean population salt intake by 2025.

• Estimates from 2010 show that globally people consume an average of 9–12 grams
of salt each day – twice the recommended daily intake
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 Tobacco use
• Tobacco use is currently one of the leading global risk factors for
illness and death from major NCDs.

• Primary smoker and second-hand smoker

• Global NCD Action Plan has a plan of 30% relative reduction in the
prevalence of current tobacco use in individuals aged 15 years and
older by 2025

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 …Tobacco use
o Globally in 2016, around 34% of men and 6% of women aged 15 years
and older were current smokers of tobacco

o High-income countries had the highest prevalence of tobacco smoking

among women 19% versus 29% men whereas in all other income groups
the average smoking rate for women was below the global average 6%.

o Analysis of trend data between 2000 and 2016 indicates that the global
prevalence of tobacco smoking in individuals aged 15 years and older
decreased from 27% to 20%.
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Age-standardized, fitted and projected global prevalence of smoking among people aged ≥ 15 years, by world bank country
income group, 2000–2025

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 Raised blood pressure
Raised blood pressure, also known as hypertension, is a major risk
factor for
Coronary heart disease,
Chronic kidney disease, and
Stroke.

• The global NCD target for hypertension is a 25% relative reduction in

the prevalence of raised blood pressure by 2025.

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 …Raised BP
o Globally one in four men and one in five women had raised blood pressure SBP/ DBP
greater than, or equal to, 140/90 mmHG.

o The highest prevalence of raised blood pressure was seen in the African Region 27%

o Prevalence of raised blood pressure in adults has declined in high-income countries

over the past few decades and is also now declining in some middle-income countries.

o In contrast, it has been stable or increasing in other low-and middle income countries

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 Obesity
o Obesity is linked to an increased risk of
Hypertension
Diabetes,
Coronary heart disease,
Stroke, and
Cancers
Obstructive sleep apnea and osteoarthritis.
• Between 1975 and 2016, the worldwide prevalence
of obesity nearly tripled

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 …Obesity
o Contributing factors to the rise in obesity
Shifts in eating behavior towards diets containing energy-dense foods,
high in fat and sugars, and less physical activity
modes of transportation.

o Some 7% of the population in low income countries were obese

compared with 25% of the population in high-income countries

o Between 2000 and 2016 prevalence of obesity increased from 9% to

13% in 2016.
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 Air pollution

o Air pollution, both indoor and outdoor, is a major public health problem
and one of the key underlying causes for millions of deaths due to
Ischemic health disease,
Chronic lung diseases, and
Cancers
o In 2016, air pollution caused 7 million deaths globally

o About 29% of adult deaths from lung cancer, 24% from stroke, and 25%
from heart disease were attributable to air pollution.

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 …Air pollution
o Air pollution caused mainly by
Inefficient energy production,
Industry
The domestic/residential sector
Poor waste management and transportation

o According to the WHO Air quality guidelines 91% of the world’s

population lived in places where the air was unsafe to breathe

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Myths and facts about NCDs
o Myth; Chronic diseases are a problem of the rich countries
Fact; NCDs account for more than half the burden of disease and 80% of
deaths in poorer countries

o Myth: NCDs are a problem only of the elderly.

 Fact: Half of these diseases occur in adults under 70 years of age, and the problems often
begin in the young, e.g. obesity.

o Myth: NCDs affect men more than women.

 Fact: NCDs affect women and men almost equally and globally. Heart disease is the leading
cause of death in women

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 …Myths and facts about NCDs
o Myth: NCDs cannot be prevented.
Fact: If the known risk factors are controlled, at least 80% of heart disease,
stroke and diabetes and 40% of cancers are preventable; in addition, there are
cost-effective interventions available for control.

o Myth: People with NCDs are at fault and to be blamed because of their
unhealthy lifestyles.
Fact: Individual responsibility, while important, only has full effect where people
have equal access to healthy choices. Governments have a crucial role to play in
altering the social environment to help make the healthy choice the easy choice.

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 …Myths and facts about NCDs
o Myth: "My grandfather smoked and lived to 90 years." "Everyone has
to die of something."
Fact: While some people who smoke will live a normal lifespan,
the majority will have shorter, poorer-quality lives. And yes,
everyone has to die, but death does not need to be slow, painful or
premature, as is so often the case with CNCDs.
o Like wise there are myths about NCD preventive programs are:
 Difficult to implement,
 Expensive,
 Ineffective

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Prevention and control of NCDs

United Nations General Assembly declaration

o UN General Assembly, a political declaration was made to strengthen global
and national responses to prevent and control NCDs (New York,2011)

o As part of the declaration, WHO was given a leadership role, and

subsequently established the WHO Global Action Plan for the Prevention
and Control of NCDs adopted by the World Health Assembly in 2013

o The Global NCD Action Plan included a global monitoring framework and
nine voluntary global targets to be attained by 2025

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 …Prevention and control of NCDs
o The first global target is a 25% relative reduction in overall mortality
from the four major NCDs
Cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases.

o Further targets relate to the reduction in NCD risk factors

Harmful use of alcohol, physical inactivity, salt/sodium intake and tobacco use
and
Metabolic risk factors; raised blood pressure, raised blood glucose
and obesity.

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Lives saved from implementing the “best
buys” for NCDs
o WHO -package of 16 “best buy” interventions that are cost-effective,
affordable, feasible and scalable in all settings.

o The “best buys” were first designated in 2011, and were updated in
2017 based on the latest evidence of intervention impact and costs.

o Implementing all 16 “best buys” in all countries between 2018 and

2025 would avoid 9.6 million premature deaths

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 16 WHO NCD BEST BUYS

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 …BEST BUYS

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 … BEST BUYS

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 Multi-level responsibility in prevention

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Policy and strategy of NCDs in Ethiopia
o It focused to address the four NCDs
Cardiovascular disease
Chronic respiratory disease
Diabetes mellitus and
Cancer and
o Four main risk factors for NCDs
Physical inactivity,
Unhealthy diet
 Harmful use of alcohol, and
Tobacco use as the main strategy.

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Selected NCDs Targets for 2020 - 2025

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…Selected NCDs Targets for 2020 - 2025

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 …Selected NCDs Targets for 2020 - 2025

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 Priority areas and strategies for the NSAP

It has four priority areas:

Strengthen the national NCD response through policy, governance, leadership and
coordination.

Health promotion and disease prevention targeting behavioral, infectious and

environmental risk factors.

Comprehensive and Integrated Screening, Diagnosis, Treatment, Care and Support for
NCDs and their risk factors.

Monitoring, evaluation and research.

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Implementation of the national strategic plan for NCDS
and risk factors

The multi sectorial response for NCDS

Strengthen the health sector response for NCDS

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 References

• WHO non-communicable diseases country profiles, 2018

• Global Burden of Disease Collaborative Network. Global Burden of
Disease Study 2019 (GBD 2019) Results. Seattle, United States: Institute
for Health Metrics and Evaluation (IHME), 2021.
• Ethiopian national strategic plan for the prevention and control of major
non-communicable diseases, July 2020
• Abdel R. Omran 1, epidemiologic transition theory revisited thirty years
later, 1999

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 Thank You!

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