Prevention and control of non-communicable diseases

Prof. Wasantha Gunathunga

Levels of prevention

Primary Secondary Tertiary

Objectives

To know approaches to prevention of NCD

To know the control measures of NCDs

Primary prevention of NCD

What areas can be improved to prevent NCDs?

Physical Mental Social Spiritual Combined

Physical

Central obesity BMI Exercise Stamina

Mental

Managing stress

Work place Marital Social

Train mind

Mental health

Teaching to relax

Primary prevention programs

NIRIGI lanka project (ministry of health website)

Walking tracks Relaxation programs MO NCD, MO mental health, MO

(MCH)

Secondary prevention

Screening

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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

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

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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

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Criteria for a screening programA. 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 phaseB. 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 diseaseD. 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

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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

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Types

Mass screening Individualized screening Routine screening

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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

Other secondary preventive strategies

Diabetic clinics Ncd clinics Routine screening

Tertiary prevention

Rehabilitation units Community based rehabilitation Other treatment forms