WELCOME Aesculapius Hygeia

NON-COMMUNICABLE DISEASES THE MODERN PANDEMIC Presenter and Author : Brig Gen Dr. S M M Saleh Bhuiyan, MBBS, MPH, M Phil Commandant, Armed Forces Medical Institute Bangladesh Armed Forces

Introduction 10 Million (26.30%) 28 Million (73.70%) Non-communicable diseases (NCDs) are the major health threat globally that kills 38 million people each year, of which 28 million are in low and middle income countries. 10 Million (26.30%) 28 Million (73.70%) Low and Middle Income Countries High Income Countries

ANNUAL DEATH DUE TO NCDS Cardiovascular diseases Cancers Respiratory diseases Diabetes 17.5 Million 8.20 Million 4 Million 1.5 Million

Non-Communicable Diseases Control and containment of Infectious Diseases Rapid and unplanned urbanization Globalization of unhealthy life style Communicable Diseases Non-Communicable Diseases

Harmful use of Alcohol Cancers Unhealthy Diets Physical Inactivity Cardiovascular Diseases Cancers Unhealthy Diets Physical Inactivity Respiratory Diseases Diabetes Tobacco Use 4 Risk Factors 4 Diseases

Risk Factors Diseases

Population at Risk Elderly Adult Children Elderly, Adult and Children all are vulnerable to risk factors that contribute NCDs

Population at Risk (Contd…) 16 million of all deaths attributed to non-communicable diseases occur before the age of 70 years. Of these 82% occurred in low-and middle-income countries.

Risk Factors (Modifiable) Tobacco accounts for around 6 million deaths every year and is projected to increase to 8 million by 2030. About 3.2 million deaths annually attributed to insufficient physical activity. More than half of the 3.3 million annual deaths from harmful drinking are from NCDs. In 2014, 2.3 million annual deaths from cardiovascular causes have been attributed to excess salt/sodium intake.

Risk Factors (Metabolic) (Contd…) Raised blood pressure Hyperglycemia (High blood glucose level) Over weight/Obesity Hyperlipidemia (High level of blood lipid/fat)

CONSEQUENCE OF NCDS ON SOCIOECONOMIC DEVELOPMENT NCDs threaten progress towards the UN Millennium Development Goals and post-2015 development agenda. Poverty is closely linked with NCDs. The rapid rise in NCDs is predicted to impede poverty reduction initiatives in low-income countries, particularly by increasing household costs associated with health care.

CONSEQUENCE OF NCDS ON SOCIOECONOMIC DEVELOPMENT (Contd..) Vulnerable and socially disadvantaged people get sicker and die sooner than people of higher social positions. Especially because they are at greater risk of being exposed to harmful products, such as tobacco or unhealthy food, and have limited access to health services.

CONSEQUENCE OF NCDS ON SOCIOECONOMIC DEVELOPMENT (Contd..) In low-resource settings, health-care costs for cardiovascular diseases, cancers, diabetes or chronic lung diseases can quickly drain household resources, driving families into poverty. The exorbitant costs of NCDs, including lengthy and expensive treatment and loss of breadwinners, are forcing millions of people into poverty annually, stifling development.

CONSEQUENCE OF NCDS ON SOCIOECONOMIC DEVELOPMENT (Contd..) In many countries, harmful drinking and unhealthy diet and lifestyles occur both in higher and lower income groups. However, high-income groups can access services and products that protect them from the greatest risks while lower-income groups often unable to afford such products and services.

NCDs Burden of Bangladesh In Bangladesh The Burden of NCDs now surpasses infectious diseases 61% of all deaths are due to NCDs

NON-COMMUNICABLE DISEASE (NCDS) BURDEN OF BANGLADESH The recent Bangladeshi NCD risk factor survey showed 60 million people consume less than the recommended amount of fruits and vegetables 33 million people use tobacco. 16 million leads sedentary lives

NCDs are rising in Bangladesh

NON-COMMUNICABLE DISEASE (NCDS) BURDEN OF BANGLADESH Recent National NCD risk factor survey showed 99% of those surveyed had at least one NCD risk factor and 29% had more than 3 risk factors. Major NCDs of Bangladesh include Diabetes Mellitus (DM), Ischemic heart disease (IHD), Hypertension, Stroke, Chronic respiratory disease and Cancer.

NON-COMMUNICABLE DISEASE (NCDS) BURDEN OF BANGLADESH . IHD tops the NCDs in our country while DM is rising in alarming rate. . Prevalence of DM in urban and rural populations are 10% and 7% respectively. Prevalence of Hypertension is 9.8% in males and 15.6% among females. Cancer claimed 1,50,000 (One hundred and fifty thousands) lives according to recent estimate of Bangladesh Cancer institute.

RESPONSE FROM WORLD HEALTH ORGANISATION (WHO) More than 190 countries agreed in 2011 on global mechanisms to reduce the avoidable NCD burden including a Global Action Plan for the prevention and control of NCDs 2013-2020. This plan aims to reduce the number of premature deaths from NCDs by 25% by 2025 through nine voluntary global targets. The nine targets focus in part by addressing factors such as tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity that increase people's risk of developing these diseases.

RESPONSE FROM WORLD HEALTH ORGANISATION (WHO) (Contd..) The plan offers a menu of “best buy” or cost-effective, high-impact interventions for meeting the nine voluntary global targets such as banning all forms of tobacco and alcohol advertising, replacing trans fats with polyunsaturated fats, promoting and protecting breastfeeding, and preventing cervical cancer through screening.

RESPONSE FROM WORLD HEALTH ORGANISATION (WHO) (Contd..) It was decided that in 2015, countries would begin to set national targets and measure progress on the 2010 baselines reported in the Global status report on non-communicable diseases 2014. The UN General Assembly will convene a third high-level meeting on NCDs in 2018 to take stock of national progress in attaining the voluntary global targets by 2025.

METHODS A cross sectional study was conducted by reviewing the NCDs related data collected from Combined Military Hospitals (CMH) of Bangladesh Armed Forces over the period of 5 years from 1st January 2010 to 31st December 2014. All NCD patients treated in CMHs were included in the study.

Main causes of mortality were Cancer RESULTS Study revealed that among the non-communicable diseases Hypertension (20.8%), Knee injuries (19.79%), Road Traffic Accidents/injuries (13.98%),Mental Illnesses (11.91%) Bronchial Asthma (10.98%),Diabetes (8.8%), Cardiovascular Diseases (8.3%), were the main causes of morbidity during the year 2010 to 2014. Main causes of mortality were Cancer (20.9%), RTA (16.71%), Cardiovascular Disease (16.14%) and other causes (46.17%).

Major Morbidity causing NCDs (Serving personnel) 2010-2014

Hospitalized Cases of Common NCDs (Including Family Members) 15778 (35.8%) 13001 (29.5%) Chronic Obstructive Pulmonary Disease Cardiovascular Diseases 2924 (6.6%) 12391 (28.1) Road Traffic Accident/ Injuries Mental Diseases

DISCUSSION This study showed that the leading Non-communicable diseases in Bangladesh Armed Forces are Bronchial Asthma, Road Traffic Accident/injuries, Cancer, Cardiovascular Diseases, Mental Illnesses and Diabetes. Bangladesh NCDs survey revealed that the Common NCDs are Cardiovascular and cerebrovascular diseases, Diabetes Chronic Obstructive Pulmonary Diseases, Cancer and Road Traffic Accidents, Occupational health hazards, mental illness and health hazards due to tobacco consumption.

DISCUSSION (Contd..) Findings of South East Asian Regional studies and WHO reports on NCDs are also consistent with the present study. However the prevalence of NCDs were relatively less among Bangladesh Armed Forces personnel probably due to military life in Bangladesh is designed to carry out regular physical training, games, sports and gymnasium activities so that military persons are less exposed to the risk factors of non-communicable diseases.

PREVENTION AND CONTROL OF NCDs To lessen the impact of NCDs on individuals and society, a comprehensive approach is needed that requires all sectors, including health, finance, foreign affairs, education, agriculture, planning and others, to work together to reduce the risks associated with NCDs, as well as promote the interventions to prevent and control them.

PREVENTION AND CONTROL OF NCDs (Contd..) An important way to reduce NCDs is to focus on lessening the risk factors associated with these diseases. Low-cost solutions exist to reduce the common modifiable risk factors (mainly tobacco use, unhealthy diet and physical inactivity, and the harmful use of alcohol) and map the epidemic of NCDs and their risk factors.

PREVENTION AND CONTROL OF NCDs (Contd..) Other ways to reduce NCDs are high impact essential NCD interventions that can be delivered through a primary health-care approach to strengthen early detection and timely treatment. Evidence shows that such interventions are excellent economic investments because, if applied to patients early, can reduce the need for more expensive treatment.

PREVENTION AND CONTROL OF NCDs (Contd..) These measures can be implemented in various resource levels. The greatest impact can be achieved by creating healthy public policies that promote NCD prevention and control and reorienting health systems to address the needs of people with such diseases.

PREVENTION AND CONTROL OF NCDs (Contd..) Lower-income countries generally have lower capacity for the prevention and control of non-communicable diseases. High-income countries are nearly 4 times more likely to have NCD services covered by health insurance than low-income countries. Countries with inadequate health insurance coverage are unlikely to provide universal access to essential NCD interventions.

Of 56 million global death annually, 38 million (68%) are due to NCDs. CONCLUSION Of 56 million global death annually, 38 million (68%) are due to NCDs. Main Risk Factors of NCDs are : Unhealthy diet, Physical inactivity, harmful use of Alcohol and consumption of tobacco all of which are modifiable and preventable.

CONCLUSION (Contd..) Since NCDs attack mostly in advance age, the serving Armed Forces personnel are not affected significantly. Moreover, routine physical activity, sports, games and due to nature of job, they are less vulnerable during service life. They mostly suffer at the verge of their retirement or after retirement from service.

CONCLUSION (Contd..) Various interventional measures are being taken to prevent modifiable risk factors of NCDs in Armed Forces. Prevention of obesity, encouraging physical activity for those trade who are mostly engaged in sedentary life (Clerk, Storemen, highly skilled paramedics etc), discouraging tobacco consumption, restriction on salt, sugar and red meat are the key intervention measures.

CONCLUSION (Contd..) Hippocrates (416-370 B.C.)

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