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In the Name of ALLAH, Ever Beneficent,
Infinitely Merciful
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Non Communicable Diseases In Developing Countries
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• Burden of NCDs
• Health transition in developing countries
• Impact of NCDs on public health

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Trends in Developing Countries
NCDs
Comm. Dis.
Injuries
40
30
Deaths (millions)
20
10
0
1990
2000
2010
2020
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• Current Projected Burden of Diseases

China
India
Rest of Asia
(Murray Lopez, 1990)
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Burden of NCDs in Pakistan
Causes of Burden of Disease (DALYs) Percentage ()
Communicable Disease 38.4
Non-Communicable Disease 37.7
Causes of Deaths Year (1992) Year (2003)
Communicable Disease 49.8 26.2
Non-Communicable Disease 34.1 54.9
The world bank. Pakistan towards a health sector
strategy. Washington, USA health Nutrition and
population unit, South Asia region, the world
bank 1998 Government of Pakistan. Respective
surveys for the years 1992-2003. federal bureau
of statistics Pakistan demographic surveys.
Islamabad, Pakistan statistics division.
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Burden of NCDs on DALYs
NCDs 5 out of 12 1.Ischaemic heart
disease 2.Cerebrovascular disease 5.Chronic
obstructive pulmonary disease 9.Trachea and Lung
Cancers 11.Diabetes mellitus
2002 Disease or Injury
NCDs 7 out of 12 1.Ischaemic heart
disease 2.Cerebrovascular disease 4.Chronic
obstructive pulmonary disease 6.Trachea and Lung
Cancers 7.Diabetes mellitus 10.Stomach
Cancer 11.Hypertensive heart diseases
2030 Disease or Injury
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Global diabetes epidemic
International Diabetes Federation
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Diabetes Developed vs Developing
Region 2000 2025
Developed countries 6.2 54.8 million 7.6 72.2 million
Developing countries 3.5 99.6 million 4.9 227.7 million
King et al,
Diabetes Care 1998 21 1414-31
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Burden of Diabetes in Pakistan

• Hypertension 40-50
• Hyperlipidemia
  30-35
• Central Obesity
  46-53
• Diabetes
  07-12

• 7.0 million have diabetes
• 14.5 million will have diabetes by 2025

1-Pakistan medical research council. National
health survey of Pakistan health profile of the
people of Pakistan. Islamabad, Pakistan Federal
bureau of statistics and Pakistan medical
research council 2- Data from M Phil June 2007,
Metabolic Syndrome and Insulin Resistance in
Pakistan a population based study in adults 25
years and above in Karachi, University of
Oslo 3-Jafer TH, et al. Heart disease Epidemic in
Pakistan Women and Men at Equal Risk. Am Heart J
2005150221-6 4-Heart file. Population-based
surveillance o Non- communicable disease 1st
round, 2005. Islamabad, Pakistan heart file,
ministry of health and world health organization
2006 5.Prevalence of diabetes in Pakistan. 
Diabetes Research and Clinical Practice, Volume
76, Issue 2, May 2007, Pages 219-222 A. Shera, F.
Jawad, A. Maqsood
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• Burden of NCDs
• Health transition in developing countries
• Impact of NCDs on public health

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Non-communicable diseases/diabetes in developing
countries
Health Transition
Rising Life Expectancy
WHO report, 1997
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Health Transition demographic transition and
epidemiologic transition
Economic, social environ mental changes
Industrialization urbanization
?public sanitation, housing, health care
? mortality (? infant mortality) ? life
expectancy ? ? fertility
? nutrition ? technology for health care
? per cap. income, ? wealth
? NCD ? infectious diseases
? persons at risk of developing NCDs
Increasing aging population
? levels of RF fat, calories, tobacco
sedentary habits
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• Burden of NCDs
• Health transition in developing countries
• Impact of NCDs on public health

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Impact of NCDs on public health in DCs

• High and rising burden upon productive middle age
  persons
• Negative micro-economic impact
• Health of household, indirect impact on
  childrens care costs
• Negative macro-economic impact
• Short term impact on costs, long term impact on
  production, long term cost escalation
• Issue of efficiency in allocation of resources
• Curative and prevention interventions

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Global burden of NCDs on DCs

• 60 of deaths worldwide
• 43 of the disease burden
• By 2020
• 73 of deaths worldwide
• 60 of the disease burden

• 50 deaths due to CVDs.

There are more CVD deaths in India or China than
in all developed countries added together.
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Economic Impact of NCDs
In 2005 alone, Pakistan lost 1 billion dollars in
national income from premature deaths due to
heart disease, stroke diabetes and will lose 31
billion dollars over next ten years if the
solutions are not implemented
http//www.idf.org/webdata/docs/background_dis_fin
al.pdf Press Release Karachi, Pakistan-26
February 2006
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NCDs in developing developed countries. Are
they same?
Impact of NCDs on Developing Countries

• The compressed time frame of transition in
  developing countries imposes a large, double
  burden of communicable and non-communicable
  diseases.

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NCDs are to a great extent preventable

• Prevention
• in developed countries
• epidemic had peaked and accelerated towards a
  downswing
• in the developing countries
• efforts starting when the epidemic is on the
  upswing.

• Simple changes in these lifestyles can prevent
  chronic diseases and promote health.

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The health transition in developing countries
possible responses ?
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Strategies to prevent the emergence of NCDs

• Demographic (populations get older)
• Not modifiable
• Lifestyle-epidemiologic (age-specific risk factor
  rates change)
• Modifiable
• Socio-economic (differential risk factors levels
  across SES)
• Modifiable
• Health services (access/use of preventive
  curative services)
• Modifiable

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Strategies to prevent the emergence of NCDs
Primary prevention (limit the number of new cases)

• Population strategy
• Public health approach
• Targets population

• High risk strategy
• Clinical management
• Targets individuals

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Preventing NCDS in developing countries a
window of opportunity
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Setting an agenda for action The example of
Pakistan

• Focus on primary prevention with health policies
• Target high risk strategies (hypertension,
  diabetes)
• National programs aimed at primary and secondary
  prevention and educational campaigns to be
  implemented.

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Setting an agenda for action The example of
Pakistan

• Identify and apply low cost and affordable
  interventions for case management
• Set surveillance systems (particularly risk
  factors)
• National diabetes plans
• 1996 98
• 1999 01
• 2001 04
• Made recommendations for prevention, management
  and surveillance

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Setting an agenda for action The example of
Pakistan

• Need to strengthen capacity building, leadership,
  partnership
• 2003 National diabetes plan was incorporated
  into
• the National Action Plan for NCDs
  (NAP-NCDs)
• MOH,
• DAP-WHO,
• Heartfile

Nishtar Shera Pract Diab Int. Oct 200623332-34
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Preventive Strategies
Podiatry Course
Future
National Foot Program
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Study on impact of intervention for the
prevention of Type 2 diabetes (a randomized
high-risk population based study in Pakistan and
Bangladesh)
BIDE-DAP-UIO Collaborative Research Study
Diabetes Prevention Trials for high-risk
subjects in Low Resource Environment
Funded by University of Oslo, Norway
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WDF BIDE PROJECT
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Integrated Masters Programs (M.Phil.) in Public
Health Research in Asia (Bangladesh-Nepal,Bhutan,
India and Pakistan) NOMA Project (2007-2010)

• Diabetic Association of Bangladesh (DAB)
• Bangladesh Institute of Research and
  Rehabilitation in
• Diabetes, Endocrine and Metabolic Disorders
  (BIRDEM)
• Bangladesh Institute of Health Sciences (BIHS)
• Baqai Institute of Diabetology Endocrinology,
• Baqai Medical University (BMU), Karachi,
  Pakistan
• Diabetic Association of Nepal together with
  Kathmandu
• University and Ministry of health-Bhutan.
• Inst. of General Practice and Community Medicine,
  
• Department of International Health,
  University of Oslo (UIO)

Funded by Norwegian Research Council
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Consultant Diabetologist Dr Abdul Basit Dr.
Yakoob Ahmedani Dr. Zahid Miyan Dr.Asim Bin
Zafar Dr Ahmed Salman
Diabetes Foot Department Dr. Syed Mansoor Ali Dr.
Farooq Chohan Mr. Farrukh Muslim Mr. Mumtaz Mr.
Aamir
BIDE-DAP-UIO Project Dr. Zafar Iqbal Hydrie Dr.
Fareeha Faisal Ms. Durashwar Ms Zara Siddiqui Mr
M Yasin Kaleem Khan Mr. Faraz Ul Islam
Junior Doctors Dr. Saheer Dr. Aziz Dr Shirjeel
Educationist Dr.Asna Dr Nausheen Mrs. Rabia A.
Rahman
IT Department Mr. Mansoor Ahmed Siddiqui Mr.
Moneeb Ghouri Mr Arif
Dietician Ms Mahwish Ryaz Mrs Safiya
Research Department Dr. Rubina Hakeem Dr. Zafar
Iqbal Hydrie Dr. Asher Fawwad Mr. Bilal Tahir
BIDE-WDF Project Dr. M Zafar Iqbal Abbasi Dr.
Azmat Dr. Aqil Ms Hira
Administration Mr Zubair Kamal Mr Abdul Rehman