Non-communicable diseases

Prof. A. Ogunniyi
Department of Medicine
College of Medicine
University of Ibadan

GES 107 Course

 Learning Objectives
At the end of this lecture, the attendee should
be able to:
• differentiate between communicable and non-
communicable diseases (NCDs)
• understand the risk factors for NCDs
• recognise the complications of NCDs
• itemize preventive strategies against NCDs
 Lecture Outline

• Introduction and Definition

• Epidemiology of NCDs
• Factors associated with increase in NCDs
• Description of Specific Examples
Hypertension
Diabetes
Obesity
Stroke & Ischemic Heart Disease
Dementia
• Preventing NCDs – useful hints
 Non-communicable diseases:

Medical conditions that occur in individuals that

are not due to transmission from one affected
person to another.
 NCDs
Diseases associated with lifestyle changes
Diseases of affluence
Diseases common in western societies
Diseases not caused directly by infections
Diseases not associated with person-to-person
spread
 Examples of NCDs
• Hypertension
• Diabetes mellitus
• Obesity
• Stroke
• Ischaemic heart disease
• Cancer
• Chronic Obstructive Airways Disease & Asthma
• Neurodegenerative diseases (Dementia, PD)
• Chronic Kidney Injury
• Traumatic Brain Injury
 Communicable diseases
• Diseases that are transmitted through contact with an
infected individual
• Transmissible diseases
• Infective conditions

Examples: COVID
Malaria
HIV
Tuberculosis
Meningitis
STIs
 Communicable Diseases
• Aetiologic agent can be diagnosed through study
of biological fluids and tissues (microbiology,
virology, genomic study)
• The diseases are usually treated with
antimicrobial agents
• Mass vaccination can eradicate these diseases
• Public health measures are important in
combating spread
 Deaths by Broad Cause Group and WHO Region (2000)
%
75

50

Source: WHO, World Health Report 2001

25

AFR EMR SEAR WPR AMR EUR

Noncommunicable Communicable diseases,
conditions Injuries maternal and perinatal conditions, and
nutritional deficiencies
 Why the interest in NCDs
• NCDs kill 41 million people each year, equivalent to
71% of all deaths globally
• Each year, 15 million people die from a NCD between
the ages of 30 and 69 years
• Over 85% of these "premature" deaths occur in low-
and middle-income countries.
• Annual deaths from NCDs:
• Cardiovascular diseases (17.9 million)
• Cancers (9.0 million)
• Respiratory diseases (3.9million)
• Diabetes (1.6 million)
 Global deaths <70 years (2016)

13%

34% Communicable diseases

Cardiovascular
Neoplasms
Diabetes
29%
Resp dis
Other NCDs
Injuries
11%
3% 2%
8%
 Global projections for selected causes,
2004 to 2030
12 Cancers

10
Ischaemic HD

Stroke
Deaths (millions)

6
Acute respiratory
infections
4 Road traffic
accidents
2
Perinatal
HIV/AIDS
TB
0 Malaria
2000 2005 2010 2015 2020 2025 2030
Updated from Mathers and Loncar, PLoS Medicine, 200

Health Statistics and Informatics

 Changing pattern of CNS Diseases in Ibadan
Diseases 1957-69* 1987-89
(N = 8637) (N = 1318)
CNS Infections 46.9% 11.9%
Myelopathy 14.3% 11.5%
Peri Neuropathy 10.6% 11.8%
Epilepsy 8.1% 20.8%
Stroke 6.9% 21.1%
Myopathies 3.8% 1.6%
Headache 2.9% 7.1%
Movement Dis 2.3% 3.1%
Neurodegen Dis 1.4% 3.6%
Miscellaneous 2.8% 7.5%

* Ref. Osuntokun 1971

Why the increase in NCDs?
 Epidemiologic transition

• Increasing urbanization
• Economic prosperity
• Increased life expectancy
• Dietary and lifestyle changes
• Change in disease pattern from infections to
non-communicable diseases
Changing dietary pattern
Carbonated Drinks and Sugar!!!
From ancient to modern work ….
From traditional to modern transportation ....
Evolutionary and
Epidemiologic
Transition
Hypertension
 Hypertension

• High blood pressure

• Usually written as a ratio
• Expressed in millimeters of Mercury (mm Hg.)
• Upper value - Systolic blood pressure
• Lower value – Diastolic blood pressure
• Normal Blood pressure
Systolic BP 120-139 mm Hg
Diastolic BP 70 – 89 mm Hg.
 Blood pressure measurement

• Sphygmomanometer
Mercury
Electronic
 Hypertension Prevalence in Nigeria
• Akinkugbe OO et al (1997) 11.2% (WHO)
Urban communities 10.7%
Rural 7.7%
• Kadiri S et al (1999) 9.3% (WHO)
JNC 7 22.2 M vs. 14.2
F
• Olatubosun ST (2000) 10.3%
• Andy JJ et al (2012) 23.6%
• Ogah OS et al (2013) 31.0%
Growing Burden of Hypertension in SSA

Ogah OS, Rayner BL 2013

 Epidemiology of Hypertension in Nigeria*
• Prevalence (age-adjusted): 9.2%
Males = 9.2%
Females = 9.3%
• Prevalence increased with age:
25-34 years = 6.5%
75-84 years = 35.0%
• Increased risk: urban dwelling
cigarette smoking
heavy alcohol consumption
physical inactivity
increased body mass index

*National Survey on NCD 1997

 Hypertension

• “The silent killer”

• It was estimated to have caused 7.6 million
premature deaths in 2001
• The on-third rule applies:
only a third are aware of the diagnosis
of these, only a third are on treatment
only a third are compliant with therapy
• Prevalence increases with age
• It damages the heart, brain, kidneys and blood
vessels.
Atherosclerosis due to hypertension
 Consequences of Uncontrolled
hypertension:
• Heart failure – effort intolerance, cough
• Cerebrovascular disease (Stroke)
• Chronic renal failure
• Retinopathy (Eye damage)
Diabetes Mellitus
 Overview

• Endocrine disease caused by absolute or relative

lack of insulin resulting in elevated blood glucose.

The deficient hormone is

INSULIN produced by the
pancreatic islets of
Langerhans.
 The Growing Epidemic

38.2M 81.8M
25.0M
 16%
 59%  91%

18.2M
13.6M  97%

 98%

10.4M
 88%
1.1M
Nigeria  59%

World prevalence
2003: 189 million
2025: 324 million
Slide No. 33 • • 72% increase
Zimmet et al. Diab Med 2003;20:693–702
 Diabetes mellitus

• Usually accompanies hypertension in causing

widespread vascular damage (microaneurysms)

• Prevalence 3X higher after the age of 45 years

• Prevalence higher in urban communities and forest

zones than in semi-desert North.

• At risk: overweight, physical inactivity, alcohol abuse,

family history
 Clinical manifestations of Diabetes:

• Varied
• Excessive urination
• Excessive thirst
• Increased apetite
• Weight loss
• Poor wound healing
• Proneness to infections – recurrent boils
• Ants crowding around urine
• Family history may be elicited
 Complications:

• Associated with poor control

• Associated with long duration of disease
• Damage to blood vessels – gangrene of digits
• Altered consciousness from very high blood
sugar level (Ketoacidosis or hyperosmolar
states)
• Stroke and Ischemic heart disease
 Complications:

• Damage to nerves – perforating ulcers,

painless burns, pins and needle sensation,
numbness, pain, loss of muscle bulk
• Damage to eyes – cataract, blindness
• Poor wound healing & proneness to
infections- amputations, chronic leg and hand
wounds.
Obesity
Obesity
 Obesity
• Excessive fat deposition in the body
• Determined by calculating the Body Mass Index =
weight (kg)/height (m2)
Normal BMI = 18.5 – 24.9 kg/m2
Overweight = 25 – 29.9
Obesity = > 30
• Waist circumference > 40 inches (102 cm) in Male
> 35 inches (88 cm) in Female
• Waist/Hip Ratio - > 0.86 in Female; >1.0 in Male
What is the primary driver of obesity?

Weight
? ?
E in E out
 Complications of Obesity
• Gall stones
• Osteoarthritis
• Sleep challenges – obstructive sleep apnoea
• Ischemic heart disease
• Stroke
• Diabetes mellitus
• Gynaecological problems
• Cancer
• Fatty Liver
 Risk factors for NCD
• raised blood pressure
• overweight/obesity
• hyperglycemia (high blood glucose levels) and
• hyperlipidemia (high levels of fat in the blood)
• Smoking
Stroke & Ischemic heart disease
Stroke and Ischemic Heart Disease
Natural history of coronary heart disease & stroke:
long evolution without symptoms

Age Artery Symptoms

atherosclerosis /signs

20 y None

40 y None
Risk factors

50 y None

Stroke
50 y +
Heart attack
+ 1 sec
MI: 1/3 sudden †
 Ischemic heart disease
• Heart attack/Myocardial infarction
• Major cause of sudden death
• Once thought to be rare in Africans
• Presents as acute onset of severe left-sided chest
pain that radiates to the arm
• If no sudden death, breathlessness follows.
• Smoking, diabetes, hypertension, abnormal lipids
are the major predisposing factors
 Stroke definition

Brain disease resulting from disturbance in the blood

supply to brain cells.
Two possible mechanisms:
Occlusion of blood flow
Rupture of vessel
Causes of Ischemic stroke
 Stroke

• Currently the leading cause of neurological admission

at the UCH, Ibadan
• Prevalence of 1.14 per 1000 (1.51 for males & 0.69 for females)
• Major cause of death and disability
• One third rule:
one third of those afflicted survive
one third are left with disability
one third die
• Sequelae include dementia, epilepsy, intractable pain
 Modes of presentation

• Sudden weakness of one side of the body

• Sudden loss of vision
• Sudden difficulty with speaking
• Loss of consciousness
• Sudden onset of headache +/- convulsions; seizures,
vomiting
• Problems with maintaining balance, hearing,
swallowing etc.
• FAST
 Risk factors for stroke

Modifiable Non-modifiable:
Hypertension
Old age
Diabetes mellitus
Heart diseases including irregular Male gender
rhythm Black race
Abnormal lipids/
Family history/Genes
atherosclerosis
Smoking
Obesity
Alcohol
Infections – HIV, etc
Sedentary life style
 Stroke-like syndromes
• Approx. 13% of strokes misdiagnosed
• Possibilities include:
Space occupying lesions in the brain
Motor weakness following epilepsy (Todd’s
paralysis)
Metabolic encephalopathy
Brain infections (Meningoencephalitis)
Hysteria
Stroke Complications
 Other stroke sequelae

• Epilepsy
• Intractable pain
• Parkinsonism
• Pseudobulbar palsy
• Sensory deprivation
Dementia
 DEMENTIA

A deterioration of intellectual functions and

other cognitive skills, leading to a decline in
the ability to perform activities of daily living
in the conscious and alert state
 Diagnostic issues:

• cognitive impairment
• impairment in activities of daily living
• Retrogression from a previous performance
level
• need for supervision in the advanced stage
• conscious and alert state
ADI 2015
 What types of patients?

• Typical complaints:
forgetfulness
misuse of words
getting lost
learning difficulties
bad judgment
poor financial/business handling
confusion (acute/chronic)
• Either Primary of Secondary (acquired)
 Functional Challenges

• Shopping
• Cooking
• Medications management
• Finances
• Communication
• Roles in the family/Office/Society
• Religious activities
• Home organization
• Recognition
• Personal grooming
 Behavioural and Psychological Symptoms of Dementia

• Agitation • Apathy
• Aberrant motor • Disinhibition
behavior • Delusions
• Anxiety • Hallucinations
• Elation • Sleep disturbance
• Irritability • Appetite changes.
• Depression
• Major challenge to family members caring for individuals with dementia
• Associated with poor outcomes, long-term hospitalization, medication
misuse and increase in care costs
 Late Stage of Dementia

• Difficulties eating and walking

• Difficulties understanding and interpreting events
• Bladder and bowel incontinence
• Inappropriate behaviour in public
• Unable to find way around the home
• Difficulties recognising relatives, friends and familiar objects
• Confined to a wheel chair or bed
 Knowledge about dementia

Factor Positive response rate

Caused by evil spirits 100%

Drugs useful in treatment 20%

Support for orthodox Rx 10%

Dementia is curable 0%

Ref. Uwakwe R. Int. J Geriatr. Psychiatr. 2000; 15: 1152-3

 Pick’s Disease

CADASIL

DLB
HD

AD
 Cancer
• Leading cause of death worldwide, accounting for
8.8 million deaths in 2015.
• The most common causes of cancer death are
cancers of:
Lung (1.69 million deaths)
Liver (788 000 deaths)
Colorectal (774 000 deaths)
Stomach (754 000 deaths)
Breast (571 000 deaths)
 Global Cancer Stats

Lung 1,608,055 cases

Breast 1,384,155
Bowel 1,235,108
Stomach 988,602
Prostate 899,102
Cervical 530,232
Oesophagus 481,645
Liver 479,744
Bladder 382,660
Non-Hodgkin’s Lymphoma 356,431
In Nigeria, 350,000 new cancer cases are diagnosed annually.
 Risk factors for Cancer with (deaths per year)

Smoking – (1.8 million deaths/year)

Being overweight/physical inactivity – (274,000 deaths)
Harmful alcohol use – (351,000)
Human papiloma virus – (235,000)
Occupational carcinogens – (152,000)

Source: Sunday Punch Oct 2, 2011

 Keeping healthy
Tobacco use, physical inactivity, harmful use of alcohol
and unhealthy diets increase the risk of dying from NCD
• Eat healthy meals
• Be physically and socially active
• Modify lifestyle
- reduce salt consumption
- stop smoking
- reduce intake of animal fat
- avoid obesity
- drink more water and less of carbonated drinks
- alcohol consumption in moderation
Prescribing treatment is no guarantee of result…
 Comprehensive Public Health
Approach
Nutrition Mass
Tobacco Media Local Health
Organizations
Media
Trade Public Lifestyle
Policies and Education
Urban (Enabling Behavioral
Environment) Risks (knowledge;
skills)
Planning
Transport Health Community
Targeted Programmes
Systems Health
(Women, Children, Youth,
Workers Organized sector etc.)

* Government * Elected Bodies * NGOs * Professional Bodies * Private Sector * Media

Cardiovascular Science
and the Public’s Health
Are We On Track for 2010?
George A. Mensah, MD, FACP, FACC, FAHA
Chief
Cardiovascular Health Branch
Centers for Disease Control and Prevention (CDC)
Atlanta, Georgia
 Acknowledgement
• Dr George Mensah
• IUHPE/CDC
• Dr. Okey Ogah
• Prof. Ikechi Okpechi, UCT
• www.googleimages
Comments and Questions