Maternal and Child Health Quiz

Lecture 2: Introduction to the Epidemiology of Non-Communicable Diseases

• Non-communicable diseases (NCDs) are a broad range of conditions not transmitted person-to-person.
• Key focus areas for global NCDs are cardiovascular disease (CVD), cancer, type 2 diabetes mellitus, and chronic obstructive pulmonary disease (COPD).
• Other NCDs include injuries, mental disorders, and reproductive disorders; some have infectious origins, like HPV.
• NCD prevalence increases with age; shared risk factors cause common co-morbidities in older individuals.

Outline

• Introduction to NCDs and the Global Burden of Disease (GBD)
• Epidemiologic transition
• NCD risk factors (upstream and downstream)
• Epidemiology of:
  • Reproductive health
  • Cardiovascular disease and Type 2 diabetes
  • Cancer
  • Respiratory diseases (COPD and asthma)

What are Non-Communicable Diseases?

• Non-communicable diseases cover a wide range of conditions not transmitted from human-to-human.
• Major focus is on CVD, cancer, type 2 diabetes mellitus, and COPD.
• Other NCDs include injuries, mental disorders, and reproductive disorders, some that can be of an infectious agent origin.

Non-Communicable Disease Epidemiology

• Epidemiology tends to focus on specific diseases (cancer, cardiovascular, respiratory) rather than a combined category of non-communicable diseases.
• Key determinants of chronic diseases are heavily influenced by globalization, specifically unhealthy diet, physical inactivity, and tobacco use.
• The Global Burden of Disease study provides a crucial initiative to collect comparable data on health loss due to diseases, injuries, and risk factors globally. This initiative offers significant collaborative efforts from global health institutions, researchers, and policymakers.

The Global Burden of Disease

• Infectious diseases and neonatal conditions dominated global health loss in 1990.
• By 2015, lower respiratory infections were the leading global cause of death after communicable diseases and neonatal conditions.
• Disability-Adjusted Life Years (DALYs) are a combined measure of premature mortality (Years of Life Lost, YLL) and non-fatal health outcomes (Years Lived with Disability, YLD) which evaluate the overall global health burden.

Epidemiologic Transition

• NCDs are on the rise globally as countries undergo the epidemiologic transition.
• Death rates from communicable diseases typically decline, while rates of disorders related to urbanization and affluence increase.
• WHO classifies diseases into three groups for mortality: communicable diseases, non-communicable diseases and intentional or unintentional injuries.

Double Burden of Disease

• Low and middle-income countries (LMICs) face a "double burden" of both communicable and non-communicable diseases.
• Globally, combined burden requires combined resources for prevention, control, and mitigation.

NCD Risk Factors

• Factors specific to the diseases and global factors (not under individual/country control) cause or contribute to NCDs.
• Urbanization (industrialization/modernization/urban culture), alteration in diets, reduced physical activity, loss of traditional cultural values, and migration (rural to urban) are among the global factors.
• Poverty significantly drives NCD rates in LMICs, influencing the burden.

NCD: Upstream and Downstream Determinants

• Upstream determinants are macro-level factors (globalization, community influence) that affect health.
• Downstream determinants are micro-level factors affecting individuals (genetics, age, individual behaviors, biological factors like blood pressure/lipid levels).

Life-Course Perspective

• Individuals respond dynamically to macro-level factors throughout their lives, impacting their risk of NCDs.
• These factors can significantly influence individual health determinants.

Social Determinants of NCD

• Neighbourhood effects
• Compositional, contextual effects (social & dynamic features of the neighbourhood)
• Integral effects (neighbourhood structural characteristics)
• Social networking can impact things like obesity.

Built Environment and NCD Risk Factor Distributions

• Built environment (human-made structures like parks) influences physical activity levels.
• Urban design impacts access to exercise, fitness, and transportation.
• Food environment factors (location, type of outlets, food quality/price) affect NCD risk factors.

Trade Agreements, Nutrition and NCD Risk Factors

• Trade agreements influence NCD risk factors primarily through their effect on agricultural production, trade in foodstuffs, and food processing.
• Trade agreements affect the food environment by influencing what foods are available.

Nutrition Transition

• A nutrition transition has occurred in many countries, driven by urbanization, economic development, technological advancements, food processing, and media influences.
• This transition has a progression through three stages: receding famine, degenerative disease, and behavioral change. Each stage has specific associated health outcomes and risk factors.

Agricultural Policies, Climate Change and NCD Risk Factors

• Agricultural policies (input, production, trade) influence agricultural production and farmer income.
• There's a complex relationship between agricultural policies, production practices, and diet.

Agriculture, Climate Change and Health

• Livestock production contributes to climate change through deforestation, energy/water consumption, and emissions.
• Food systems have a profound influence on health outcomes and climate, which are tightly linked.

Reproductive Health

• Understanding the determinants of reproductive health is essential for successful reproduction and population health.

• Reproductive health encompasses conception, pregnancy, childbirth, and the neonatal period. It's essential for good individual and population health.

• Reproductive health issues include infertility, fetal death, stillbirth, birth defects, abnormal fetal growth, preterm delivery, maternal death, and neonatal death.

Reproductive Health: Maternal Mortality

• Maternal mortality is the death of a woman while pregnant or within 42 days of termination, caused by (related to) pregnancy-related experiences or their management.
• Direct maternal deaths are resulting from obstetric complications.
• Indirect deaths are from pre-existing conditions exacerbated by pregnancy.

Reproductive Health: Estimates of Maternal Mortality

• Maternal mortality rates vary significantly across countries. This variation in death rates is geographically uneven, with some regions experiencing much higher rates than others.

Reproductive Health: Stillbirth Trends

• Rates of stillbirth vary significantly around the world, with some countries experiencing high rates of stillbirth.

Respiratory Diseases: COPD and Asthma

• Chronic obstructive pulmonary disease (COPD) and asthma are prevalent respiratory conditions.
• COPD involves airway dysfunction with persistent airflow limitation, often irreversible, and is not fully reversible.
• Asthma symptoms can vary and are associated with different mechanisms and severity.

COPD and Asthma: Burden

• Asthma is a significant global health issue with increasing prevalence in both high-income and low-middle-income countries.
• Significant healthcare costs are associated with addressing and managing asthma.
• Asthma prevalence varies across populations.

Asthma Prevalence

• Prevalence of asthma symptoms (wheezing) varies widely.
• Asthma is prevalent in low and middle-income countries and increasingly affecting many countries.

COPD: Burden

• COPD is characterized by disability and is associated with frequent exacerbations, impact on daily functions (walking, washing, dressing), and sleep.
• Associated high healthcare costs come from frequent hospitalizations and worsening of the illness.

COPD Prevalence

• Prevalence of COPD, specifically stages 2 or higher, has been observed to increase with age.

Asthma: Genetic and Environmental Risk Factors

• Certain genes contribute to asthma development.
• Interactions with environment factors are influential in asthma development and severity.
• Smoking, lower socioeconomic status, and exposure to pollutants, are risk factors for the development and exacerbation of asthma symptoms.

COPD: Genetic and Environmental Risk Factors

• Genetic factors, like alpha-1-antitrypsin deficiency, impact susceptibility to COPD.
• Risk factors include gender, age, socioeconomic status, smoking, and exposure to air pollution (especially indoor pollution from biomass fuels).

Cancer Epidemiology

• Cancer encompasses various types of diseases and affects all age groups, although risk generally increases with age.

Cancer: Biology

• Cancer develops from mutated cells, and several stages can occur in this progression.

Cancer Characteristics

• Specific characteristics like resisting cell death, sustaining proliferative signaling, evading growth suppressors, activating invasion and metastasis, and inducing angiogenesis.

Cancer Types

• Different cancers are categorized by their location and cell type. This helps in detailed analysis of their origin and progression.

Cancer Staging

• Staging involves evaluating tumour size, lymph node involvement, and organ spread to create a stage classification.

Cancer Detection

• Detection methods include clinical examination, imaging techniques (MRI, CT scans), endoscopy, and histological confirmation.

Cancer: Measuring Burden

• The burden of cancer (incidence, mortality, and prevalence) can have several different expressions.
• Incidence includes the new cases reported in a defined area.
• Mortality measures the cases that resulted in death within a specific time frame.

Common Cancers: Trends

• Cancer survival has improved due to improved diagnosis and treatments, but the overall number of cases continues to rise globally, with greater burdens in low and middle-income countries.
• Key cancers like lung, breast, cervical, stomach, colorectal, and prostate cancers will be reviewed for trends, indicating the geographical distribution and incidence rates.

Cancer: Prevention

• Cancer prevention involves addressing modifiable risk factors and improving early detection.

Cardiovascular Diseases and Type 2 Diabetes

• Cardiovascular disease (CVD) is a range of conditions affecting the heart and blood vessels, including coronary artery disease, stroke, and angina.
• Type 2 diabetes is a condition wherein the body struggles to regulate blood glucose levels efficiently.

Cardiovascular Diseases and Type 2 Diabetes: Epidemiology

• The prevalence of diabetes and CVD is examined globally.
• Epidemiological factors, including genetics, individual behaviors, and environment, are influencing factors in both conditions.

Cardiovascular Diseases: The Global Burden of Disease Study (2019)

• CVD was a top 1 or 2 cause of death globally, regionally, and by sex analysis.

Diabetes Epidemiology

• Type 2 diabetes is a major global concern.
• The incidence of type 1 diabetes is unclear in low-income countries.

Cardiovascular Diseases and T2 Diabetes: Factors

• Risk factors for CVD and T2D include changing lifestyles, prevalence of risk factors, hypertension, smoking, and the growing aging population.

CVD and T2D factors: Blood Pressure

• High blood pressure (systolic pressure) and low blood pressure (diastolic pressure) are examined in relation to risk of CVD and T2D

CVD and T2D factors: Obesity

• Obesity is linked to increased CVD and T2D risk.

CVD and T2D factors: Smoking

• Smoking is a major risk factor for both CVD and T2D.

CVD and T2D factors: Cholesterol

• Epidemiologic studies show a strong association between high levels of LDL cholesterol and lower HDL levels and CVD.

Thank You! Questions?

• This segment of the presentation/lecture is an invitation for the audience to interact and inquire.

Test your knowledge on maternal mortality, cancer staging, and child health initiatives in this informative quiz. Dive into key concepts about the causes of maternal death and cancer detection methods. Perfect for those studying public health or midwifery.