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