Prevention and control of non-communicable diseases

1. Prof. WasanthaGunathunga Prevention and control of non-communicable diseases

2. Levels of prevention • Primary • Secondary • Tertiary

3. Objectives • To know approaches to prevention of NCD • To know the control measures of NCDs

4. Primary prevention of NCD

5. What areas can be improved to prevent NCDs? • Physical • Mental • Social • Spiritual • Combined

6. Physical • Central obesity • BMI • Exercise • Stamina

7. Mental • Managing stress • Work place • Marital • Social

8. Train mind

9. Mental health • Teaching to relax

11. Primary prevention programs • NIRIGI lankaproject (ministry of health website) • Walking tracks • Relaxation programs • MO NCD, MO mental health, MO (MCH)

13. Secondary prevention

14. Screening

15. The presumptive identification of unrecognized disease or defect by the application of tests, examinations or other procedures which can be applied rapidly to sort out apparently well persons who probably have a disease from those who probably do not

16. The basic concept is finding a condition or disease before obvious signs or symptoms have appeared - asymptomatics

17. Screening • Test asymptomatic people to classify them as likely or unlikely to have a particular disease eg. Pap smear • Leads to further investigations to reach a final diagnosis eg. Biopsy • Goal is to reduce morbidity or mortality from the disease being screened for by early treatment of cases • Screening is the major form of secondary prevention

18. Criteria for a screening program A. The disease • Should be an important health problem in terms of impact on the individual and society • Natural history should be known • The disease or condition should be common ( P&I) • There should be a recognisable latent or early detectable preclinical phase B. The screening test • Suitable test should be available ie. sensitivity, specificity, PPV • Screening should be repeated at intervals determined by natural history • Accurate % acceptable C. The treatment • Should have an effective treatment for early stage disease D. The screening program • Benefit should be greater than harm • Costs • Case finding should be a continuous process and not a “once and for all” project

19. Screening vs diagnostic tests • Diagnostic tests are usually performed in people with signs or symptoms of disease • Screening tests are performed in asymptomatic persons • Population vs individual perspective • Benefits of testing must outweigh any negative effects that may arise including physical, psychological and monetary

20. Types • Mass screening • Individualized screening • Routine screening

21. Examples of screening Breast cancer: Mammography for women >50yrs Cervical cancer: Pap smears Colon cancer: Faecal occult blood tests and sigmoidoscopy Cardiovascular disease: Blood pressure, Cholesterol Neonatal screening - PKU (Phenylketonuria) Antenatal screening - HBsAg, VDRL

22. Other secondary preventive strategies • Diabetic clinics • Ncd clinics • Routine screening

23. Tertiary prevention • Rehabilitation units • Community based rehabilitation • Other treatment forms