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Endemic NCDs in Your Community

By Aaron Beals | 28 Feb, 2011

NCDs in low-resource settings are often linked to infectious, hereditary, and environmental risk factors.

Such NCDs include (but are not limited to): rheumatic heart disease, cardiomyopathies, malignant hypertension, pericardial disease, malnutrition-associated diabetes mellitus, goitre, biomass-fuel associated chronic respiratory disease, asthma, cervical cancer, breast cancer, leukemias and lymphomas, Kaposi’s sarcoma, hemoglobinopathies, hyperreactive malarial splenomegaly, epilepsy, embolic and hemorrhagic stroke, depression and anxiety, schizophrenia, bipolar disorder, dental caries, cataracts, chronic osteomyelitis, muscoloskeletal injury, and chronic kidney disease.

What do you see in your community and what challenges and solutions have you seen in your practice?

Replies

 

jayanth devasundaram Replied at 10:36 AM, 1 Mar 2011

As with any "system", monitoring and feedback loops are necessary for control. A well developed monitoring system, perhaps based on cloud computing and crowdsourcing, would be highly desirable.

Symaque DUSABEYEZU Replied at 1:44 PM, 1 Mar 2011

In our community some people think that NCDs are "poison disease " but when they get some information about NCDs or some counseling when a patient come in the NCD CLINIC he has a good improvement after taking medication or after cardiac surgery for patients with Rheumatic Heart Disease .It meaning that all health practice have a work to explain NCDs in our society and give a counseling also saying that" NCDs are not poison diseases " and if a patient is taking a traditional medicine that diseases must be very aggravated (worsen) .
THANKS

Mateus Kambale Sahani Replied at 12:52 AM, 2 Mar 2011

NCDs constitute a high public health priority and people are not aware that they are priority. There is no specific programs for monitoring of these diseases and this increase the prevalence and mortality. So awareness and government involvement are very important to tackle NCDs.

Thank you,

Dr Mateus.

Chandarith Cheang Replied at 5:44 AM, 2 Mar 2011

NCDs are big problems for community as they are not aware of even health professionals are not clear how to deal with them, goverment has limited services for NDCs, very few NGOs or private can manage them. Patients once they got these diseases, just wait until become sick or disable they go to seek medical care, which is too late. Healt care providers should increase awareness of NCDs to community and advocate goverment or NGOs to set up clinics for patients.
Thanks,
Darith

Jeff Meer Replied at 2:08 PM, 4 Mar 2011

From my point of view as an advocate, one of the most important lessons I learned at the conference was how intimitely connected many NCDs are with infectious diseases. From Kaposi's sarcoma and HIV, to rheumatic heart syndrome and streptococcus infection, to splenomegaly and malaria, there are myriad ways in which the lines between the two types of disorder are crossed. From a policy point of view, this may be an exceedingly important point as we try to make the case that funds now targeting infectious diseases can and should also target NCDs. In short, as Dr. Mbanya said, the line between NCDs and infectious diseases is "a false dichotomy."

Robert Dedmon Replied at 2:43 PM, 4 Mar 2011

This is an interesting point, and worthy of further discussion, especially
in light of budgetary constraints globally and the critical shortage of
HCW's where they are most needed. As health professionals and policy-makers
come to understand and implement needed changes in education/training and
the importance of health-care infrastructure is a critical factor in future
success, the current silo/specialty and rigid curricular structures will
evolve into more realistic forms meeting the needs of populations. While my
focus is on public health issues such as rabies, I believe it important to
note that diseases such as diabetes- a growing problem (e.g. Thailand, where
I am most familiar). Diarrheal disease still kills 4 million people a year,
and aging in China and Japan result in more dementia and pressure on HWC
supply. As others have repeatedly pointed out, the broader system of global
health care needs to move from vertical/silo to 'diagonal' buttressed by a
solid primary care infrastructure. (note progress in TB/HIV-aids folks now
talking to each other).

Best regards,

Bob Dedmon

ROBERT E. DEDMON MD MPH FACP FACOEM
THEDA CLARK MEDICAL CENTER NEENAH, WI USA
CLINICAL PROFESSOR , INSTITUTE FOR HEALTH & SOCIETY-GLOBAL HEALTH
PROGRAM/MASTERS OF PUBLIC HEALTH PROGRAM, MEDICAL COLLEGE OF WISCONSIN, MILAUKEE
WI, 53226
MEMBER, EDITORIAL ADVISORY BOARD, ASIAN BIOMEDICINE, CHULALONGKORN
UNIVERSITY, BANGKOK ,THAILAND
MAILING ADDRESS: 333 PARK DRIVE, NEENAH, WI 54956-2875 USA
PHONE 920-725-3939, FAX 920-725-1011, CELL 920-540-3631

Dr. Ntizimira R. Christian Replied at 9:11 AM, 6 Mar 2011

we face everyday with people with NCD's in our hospital,it's a big challenge for our system and our country.As we are able now to diagnose those pathologies we need also to improve the way we manage them but how could we do that? skills and experiences needed.

Hannah Nicholls Replied at 5:31 AM, 15 Mar 2011

Non-communicable diseases (NCDs), including cancer, cardiovascular disease, chronic respiratory disease and diabetes, are the world’s number one killer causing 60% of deaths globally. A staggering 18 million women die every year from NCDs. These diseases represent a major threat to women’s health, increasingly impacting on women in developing countries in their most productive years.
In response to the lack of awareness around this critical issue for women's health, the NCD Alliance has released a landmark publication, “Non-communicable diseases: A priority for women’s health and development”. This publication is the first to focus on the specific needs and challenges of girls and women at risk of, or living with NCDs. It aims to draw attention to these diseases and key risks factors particularly tobacco control as a priority for women’s health and development and stimulate policy dialogue in the run-up to the UN Summit on NCDs in September.

Attached resource:
  • Non-communicable diseases: A priority for women’s health and development (download, 892.9 KB)

    Summary: Non-communicable diseases (NCDs), including cancer, cardiovascular disease, chronic respiratory disease and diabetes, are the world’s number one killer causing 60% of deaths globally. A staggering 18 million women die every year from NCDs. These diseases represent a major threat to women’s health, increasingly impacting on women in developing countries in their most productive years.
    In response to the lack of awareness around this critical issue for women's health, the NCD Alliance has released a landmark publication, “Non-communicable diseases: A priority for women’s health and development”. This publication is the first to focus on the specific needs and challenges of girls and women at risk of, or living with NCDs. It aims to draw attention to these diseases and key risks factors particularly tobacco control as a priority for women’s health and development and stimulate policy dialogue in the run-up to the UN Summit on NCDs in September.

    Source: NCD Alliance

Helena Nam Replied at 8:25 AM, 4 Apr 2011

As an Oncologist in Uganda, the main challenges experienced are superstition, stigma and late detection of cancer. Without raising the public health profile of cancer and NCDs and sensitizing the public to cancer and early detection, the battle to treat cancer patients becomes almost insurmountable

Marina Rajan Joseph Replied at 1:19 AM, 24 May 2011

I come from Kerala, India. Our demographic pattern resemble that of some of the developed countries. Our common NCDs are Diabetes mellitus, Cancers, Hypertension, and cardiovascular diseases.

Mohamed Labib Replied at 4:58 PM, 8 Jun 2011

Dear Colleagues
I noticed that all NCDs mentioned are medical and pediatric diseases and there are no any topic related to trauma and emergency non traumatic surgery which is very ignored in Africa

Sarah Arnquist Replied at 5:41 PM, 8 Jun 2011

Dear Mohamed,

Your comment is right on and extremely timely. Next week -- June 13-17
-- GHDonline will host an expert-led discussion on
*Building Capacity For Pre-hospital Care Delivery in Developing
Countries*. Emergency
medicine and trauma care experts with experience working on every continent
will lead a discussion around designing, implementing and evaluating
prehospital care training courses. The discussion will span topics
including, necessary considerations when developing appropriate training
curriculums in various settings; how to involve a variety of important
stakeholders; how to measure the effectiveness of a training program, and
how to maintain the quality of the trainees over the long term.

We hope you and the NCD community will join the discussion to ask questions
and share your knowledge and expertise.

Regards,

Sarah Arnquist, MPH
GHDonline Community Manager

Sandeep Saluja Replied at 6:34 PM, 8 Jun 2011

An important aspect which needs to be remembered is that on the community setting,it is the same health care provider who handles all specialties.No doctor receives adequate training in all specialties during his or her formal training and therefore we all face major problems when we are confronted with a person with a problem we may not be comfortable handling.
On a lighter note,I recall seeing a diagnosis of SBSD written on the cards of some patients of a senior colleague many years ago--only to later realise that it meant -- some bloody skin disease!

Nathalie MEZGER Replied at 5:10 AM, 9 Jun 2011

I must say that I am a little bit afraid on how the NCD issues is presently adressed. Yes, we must clearly fight NCD, but not at the price of forgetting the rest which up to now remains unsolved, eventhough better controlled (diarrhea, HIV, TB,...) and is often embedded with NCD.
The question is how to integrate/connect these issues without making a huge swing effect, diverting ressources (money, HR) from one side to the other.(i.e.: how to attract money without making your issue more "sexy", more competiting and very targetted (ie vertical)?)
Do we forget that at the end of the chain there is only one HC system, with a defined number of HCW, dealing with a patient/personn who will suffer from various problems crossing these artificial vertical borders? Of course it is not an easy problem with a ready to use solution. But we should keep in mind that while adressing these issues.

Regards,
Nathalie Mezger MD, DTMH, MPH

Alice Grainger Gasser Replied at 9:51 AM, 9 Jun 2011

Important is INTEGRATION....using existing systems created for communicable diseases and expanding them to accommodate NCDs as well. If we do that then NCD dependence on communicable disease systems will ensure that they are not competing.

Alice Grainger Gasser
World Heart Federation

Alice Grainger Gasser | Project Manager | World Heart Federation | 7, rue des Battoirs | P. O. Box 155 | 1211 Geneva 4 | Switzerland | Phone +41 22 807 03 33 | Fax +41 22 807 03 39 | E-mail | Web www.worldheart.org 
The World Heart Federation is committed to helping people achieve a longer and better life through prevention and control of heart disease and stroke, with a focus on low- and middle-income countries.

Sandeep Saluja Replied at 10:49 AM, 9 Jun 2011

I agree.In fact at the community level,it will be the same set of health care workers who will take care of all aspects!

Dr. Ntizimira R. Christian Replied at 2:58 PM, 9 Jun 2011

NCD's diseases need more effort than CD's especially from CHWs but i agree also that integration is the key for better management. As long as the priority of health leaders will change according to the fund given to a specific program more than the health system, that will create a loops.

Dr. Ntizimira Christian
Palliative care Educator

Erin Meier Replied at 3:28 AM, 15 Jun 2011

We see all of these in Papua New Guinea. The difficult part is trying to help the pts understand that most of these are diseases for life and that they have to keep taking their medicines. Many come back after getting 2 wks of meds and don't come for followup and say 1 month later, I still have the same problems. It is challenging to diagnose some of these in limited resource settings, but you can find a lot if you look and unfortunately, a lot of NCDs aren't found because many health care providers aren't aware they exist. So continuing to educate our health care providers is important.

Alice Grainger Gasser Replied at 8:27 AM, 15 Jun 2011

Has anyone put this resource up?
Alice

Alice Grainger Gasser | Project Manager | World Heart Federation | 7, rue des Battoirs | P. O. Box 155 | 1211 Geneva 4 | Switzerland | Phone +41 22 807 03 33 | Fax +41 22 807 03 39 | E-mail | Web www.worldheart.org 
The World Heart Federation is committed to helping people achieve a longer and better life through prevention and control of heart disease and stroke, with a focus on low- and middle-income countries.

NICHOLAS THADEUS KAMARA Replied at 6:40 AM, 15 Jul 2011

How committed is the World Heart Foundation. Which countries are the beneficiaries.

Kamara

joselyn rwebembera Replied at 6:17 AM, 18 Jul 2011

NCDs are a huge medical problem in developing countries. On our general medical ward, for example, close to 40% of the admitted patients will be having cardiac failure (myriad of causes), and chronic kidney disease. Also, the diabetes clinic is one of the busiest clinics in the hospital. Most of the physicians at this referral hospital are equiped with the necessary knowledge re: how to manage these conditions, but our hands are always tied by the lack of ideal drugs and other resources that would improve these patients' quality of life and prolong their life expectancy. We still need our government and the international community to be more supportive, so that we stop seeing the large numbers of heart breaking, preventable deaths!!!

Sandeep Saluja Replied at 2:12 AM, 19 Jul 2011

One important aspect which tends to be ignored all through is the commercial stake of various parties involved.For instance,if a patient with coronary artery disease was to come,many of us would consider it impardonable not to do angiography and then angioplasty/CABG.This is so despite data to the contrary which shows benefit only in a small minority.We tend to forget the commercial pressures which go behind findings presented at conferences and then finding their way into text books.Interestingly,many patients are made to believe that their arteries re like plumbing pipes and if there is a block,it just has to mechanically opened.
If only all these dollars were to go into preventive exercises and even those who already suffer were to get adequate emphasis on life style issues!

Alice Grainger Gasser Replied at 9:39 AM, 25 Jul 2011

Here is the link to the NCD Alliance paper on NCDs in children
http://ncdalliance.org/sites/default/files/resource_files/20110627_A_Focus_on...

Alice

Alice Grainger Gasser | Project Manager | World Heart Federation | 7, rue des Battoirs | P. O. Box 155 | 1211 Geneva 4 | Switzerland | Phone +41 22 807 03 33 | Fax +41 22 807 03 39 | E-mail | Web www.worldheart.org 
The World Heart Federation is committed to helping people achieve a longer and better life through prevention and control of heart disease and stroke, with a focus on low- and middle-income countries.

Alice Grainger Gasser Replied at 9:47 AM, 25 Jul 2011

@Nicholas Kamara,
Regarding your question about World Heart Federation (not World Heart Foundation....that is a different organization which focuses on heart surgery.....).
We are the federation of cardiology societies and heart foundations and other networks and NGOs dedicated to heart health around the world, and we have a lot of different activities with beneficiaries in different countries. Check out our website: www.worldheart.org

We have just put out some factsheets on NCDs and diet and activity in low-resource settings...here is the link http://www.world-heart-federation.org/what-we-do/awareness/children-youth/fac...

Marie Connelly Replied at 12:01 PM, 22 Dec 2011

Thank you all for such a rich discussion! We've summarized your comments in a peer-reviewed Discussion Brief, available to logged in members through the discussion, or by visiting https://www.ghdonline.org/ncd/discussion/endemic-ncds-in-your-community/brief/

Please continue to add your replies and share the most commonly diagnosed NCDs in your communities, as well as your suggestions for how governments and organizations can prioritize and integrate NCD care into existing health care delivery systems, resources for training health care workers to identify and treat NCDs, or strategies for combating stigma associated with NCDs.

Bayena Mirabel Kejika Replied at 11:40 AM, 2 Mar 2016

In the area where I work, Diabetes, Hypertension and Asthma are at increased rate. The big challenge with most of NCDs is the fact that they cannot be cured. For instance Hypertension and Diabetes. Patients ask on daily basis when they will be liberated from these. Some are tired of taking medicines everyday and just stay away from clinics. Traditional herbalist have claims to cure these diseases and the claim has a great tool on patients. These traditionalists claim the health care system want patients to keep coming to them, reason why they don't want to produce a cure for these diseases. Still other clients go to the preachers and Pastors to be prayed for since they desperately need a cure. The lack of availability of guidelines on how to diagnose and treat these diseases contributes to high rates of complications and hence deaths. The availability of medicines for these these groups of patients is also a challenge. Even when they are available, the next question to ask is "Are they of good quality, safe and efficacious"? because the issue of counterfeit medicines is not limited to other classes of medicines. The Government should improve availability of medicines to these groups at affordable prices. The trade in anti Diabetics and Anti Hypertensives should be restricted to health organizations. Awareness should be increased via Radio and T V programs to avoid the rampant deception that is going on.

shahidul haque Replied at 12:40 AM, 3 Mar 2016

I am not a doctor but working in the community from last 30 years specially for the development of the physically challenged people and to prevent the childhood disability. One of the major cause of the child with disability recently is coming up that is RICKETS. Going to understand the root causes of this disease some question raises in my mind, I am just placing that what I think we need to give our attention in that area to get a clue how to minimise the Non communicable disease (NCDs).

1. why NCD was not like this before 30-40 years.
2. what was the quality of our food before.
3. what we used to cook and to prepare the food before and what we are using now?
4. what was the source of drinking water before and what is now?
5. what was the housing pattern where would live and sleep before and what is now?.
I do not know whether there is any study on that or not. But what i find going to find the root causes of RICKETS in tropical countries like in Bangladesh that there is lack of calcium in the food what is not supporting vitamin-D to synthesise in the body. As a result a large number of children are going to suffer from this disease.

ALICE OJWANG Replied at 3:03 AM, 3 Mar 2016

Dear Bayena, I hear you. The situation is pathetic.We agree that helath professioansl reall work hard at managing theses conditions. However, I think they must work harder, be more creative and see results. Is it amazing that the health care quality has improved over the years in almost all countries. Knowledge of prevention and management of NCDs have improved and easily accesible, yet the prevalance esclalates? Where are we going wrong?, Is it leadership? professionals?, what messages are we giving to the patients, whoc include even the leath professioanls themslves? We  must reallycritically assess where the problem lies. Create awareness  on these conditions. Provide health education, to the already afflicted patients. Unfortunately alot fo them cannot even afford nedications, and if they can afford, only for a time and then they cannot continue to buy. Then what?.

It is also obvious from your  experiences that prevention campaigns needs to be on top of the agenda. The challenge I have with other health  professionals  is that dieticians and nutritionist are never  part of the team. Yet food is the biggest risk factor for all these conditions.
Think about it.

If we can work with dieticians and nutritionist as part of the teams, we will get somewhere with prevention and even management of some conditions including diabetes and blood pressure.

Unfortunatly, it is very epensive to get air time on TVS and Radios for health education. But we must try.
Keep up the good work all of you.
 Alice A. Ojwang (Katikro)
Nutrition and Dietetic Consultant (ANLP 2013)Technical University of Kenya.Department of Human Nutrition and Dietetics
Nairobi-Kenya

Jacob Wasag Replied at 11:15 PM, 3 Mar 2016

I agree wholeheartedly with all of the comments being raised on this issue, especially the lack of input from nutritionists and dieticians. I am a medical student in the United States and it is boggling how little those disciplines are a part of our curriculum, despite the huge impact food will have on the patients we will see for a very long time.

Another issue I wanted to raise was that not only is education a challenge, but access to nutritious food can be an even bigger challenge. Before beginning my medical studies I worked in southern Belize and despite all of the education we offered our rural patients, access to fresh fruits and vegetables was hours away, and needed to be paid in currency -- which was often difficult to come up with in communities that relied on seasonal cash crops (essentially corn).

Florence Tushemerirwe Replied at 3:18 AM, 4 Mar 2016

I love this discussion. The truth is that our lifestyles have a huge
contribution towards the escalating NCDs prevalence globally. Lifestyle
interventions have worked, we only need a good approach to share
information.

Alice, I agree with you and I am happy to meet you here. Dieticians and
Nutritionists have not been on board to share knowledge to prevent these
conditions. Our Ministries of Health focus more on treatment than
prevention. Currently, the drive is towards prevention, although a large
part of the World is investing in pharmaceuticals - it encourages people
to eat anything and pop the pills - this is my opinion. Where I work, there
are people who are affected by NCDs and are looking for opportunities to be
trained to manage the conditions and help to educate the community to
prevent these NCDs. These are people who live in rural areas and are
greatly affected.

Shahidul, we are in a nutrition and epidemiological transition. We prefer
processed highly sugarly/salty food compared to the traditional wholesome
food. For example, in Uganda, we have fresh food all the time - and
affordable at that. The rural areas sell their nutritious food to the town
dwellers. Majority of the town dwellers consume more of the processed foods
than fresh, they are convenient as they run form one job to another, making
money that they end up spending a few years down the road to treat NCDs.
People exercise less, yet this is one intervention that solely prevents a
lot of the NCDs. There is increasing under-nutrition and overweight and
obesity. Whom do you save and how do you do it in a country that has plenty
of solutions?

Bottom line - lack of nutrition and health knowledge is one issue we must
address to solve these problems. Approaches should involve practical
sessions - people need to be taught and to be encouraged that they have the
power and resources to control and prevent these health challenges.

Lets keep the discussion going.

Florence

Christine Morton Replied at 3:38 AM, 4 Mar 2016

I think making a difference in this area will have to come from education youth. Habits of eating fast foods and convenience foods start as children. Food is associated with comfort and providing children with whole, healthy foods when they are hungry sets them up to look for those foods as they grow up and are in charge of their own nutrition. If activity and exercise is fun and associated with feeling good as well then people are more likely to continue seeking this kind of activity as adults.

shahidul haque Replied at 4:00 AM, 4 Mar 2016

I liked the discussion of NCD. Another thing noticing how government and
multinationals are coming forward to invest money on Hospital set up.

Florence I like your discussion that now by the name of health care
everyone is interested to to more hospital and to setup pharmaceutical
industries. Rather than preventive steps more profit is in the arena of
curative steps. As here profit is a matter so global development is being
designed in such a way so that human being bound to think only for now.

When we are talking about nutrition and WFP is working on this issue
globally there my observation is mostly people are being learned from this
type of nutritional program only to take the supplement food. It is OK to
overcome from this malnutrition need supplement but to maintain this
nutrition does only needs food?,

What about family environmental or hygiene, what about social
hygiene/nutrition.due to climate change crop production and its diversity
is being changed in that case what is the role of the health politicians
and what whom they need to consult for an effective and efficient future
human resources those who will lead this globe.

Yes Florence i like the diet prescription i think if all stakeholder would
think more on diet habit to keep health out of danger? why there is no
doctor are talking about food production should be without any pesticide
and chemical.

At the end i am not sure how it will be to you all Nutrition should not be
packaged only with supplementation.It needs to include with Hygiene of the
family members from body, environment of the family,quality of the drinking
water and sanitation, I am not talking this is not in nutrition it is but
in practice and when we prescribe then it is mainly blocked with food.
which should not be.

Md.Shahidul haque



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Florence Tushemerirwe Replied at 4:00 AM, 4 Mar 2016

Hi Christine, I agree. If you want a tree to grow up bent, you bend it
while it is still in the seedling stage.

Anuj K. C. Replied at 5:37 AM, 5 Jul 2017

Ncd is a big problem in our community especially copd and diabetes more important than treatment in these patient are prevention and early detection of these kind of diseases. So government has to setup some programme towards early diagnosis and awareness of these kind of diseases regularly.

Chalchisa Abdeta Replied at 6:13 AM, 5 Jul 2017

In Ethiopia, NCDs are highly affecting our society where the four major risk factors are not removed especially on physical inactivity. There is a huge scarce of physical activity human power in the country. I am promoting it on social media since 2015. But, all societies are not use social media. Lack of financial support hinders me to implement community friendly physical activity interventions.
Kindly,

Mr. Chalchisa Abdeta (BSc, MPH)
Ethiopia's Physical Activity Card Country Contact

Mohammad Jawed Quereishi Replied at 12:00 PM, 5 Jul 2017

There has been a big shift in the health burden of the country with a change from communicable to non-communicable diseases (NCDs) in India. Even adolescents are suffering from it.

This Community is Archived.

This community is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.