By:

Maria Christina E. Bay, RN, MAN

NON-COMMUNICABLE DISEASE PREVENTION AND

CONTROL
I. INTEGRATED COMMUNITY BASED NON-
COMMUNICABLE DISEASE PREVENTION AND
CONTROL PROGRAM

 Four major non-communicable diseases(also known

as chronic diseases or lifestyle related diseases):
-cardiovascular diseases
-cancer
-chronic obsructive
pulmonary diseases
-diabetes mellitus
-IN 2005, IT WAS ESTIMATED THAT 35 MILLION DEATHS WOULD
HAVE OCCURRED DUE TO THESE DISEASES, CONTRIBUTING 60%
OF DEATHS WORLDWIDE.
-THE MOST WIDELY USED SUMMARY MEASURE OF THE BURDEN
OF DISEASE IS THE DISABILITY ADJUSTED LIFE YEAR OR DALY,
W/C COMBINES THE NUMBER OF YEARS OF HEALTHY LIFE LOST
TO PREMATURE DEATH WITH TIME SPENT IN LESS THAN FULL
HEALTH. ONE DALY CAN BE THOUGHT OF AS ONE LOST HEALTHY
YEAR OF LIFE.
-IN THE PHILIPPINES, INCREASING LIFE EXPECTANCY,
URBANIZATION AND LIFESTYLE CHANGES HAVE
BROUGHT ABOUT A CONSIDERABLE CHANGE ON THE
HEALTH STATUS OF THE COUNTRY.
-GLOBALIZATION AND SOCIAL CHANGE HAS
INFLUENCED THE SPREAD OF NON-COMMUNICABLE OR
LIFESTYLE/DEGENERATIVE DISEASES BY INCREASING
EXPOSURE TO RISK.
-THE LIFE EXPECTANCY OF FILIPINOS IN 2002 HAS GONE UP TO
69.6 YEARS. THE PROCESS OF AGING BRINGS OUT PROBLEMS
THAT ARE DEGENERATIVE IN NATURE.
-MORTALITY STATISTICS IN 2002 SHOWED THAT 7 OUT OF 10
LEADING CAUSES OF DEATHS IN THE COUNTRY ARE DISEASES
W/C ARE LIFESTYLE RELATED:
1.DISEASES OF THE HEART AND THE VASCULAR SYSTEM
2.CANCERS
3.COPD
4.ACCIDENTS
5.DIABETES
6.KIDNEY PROBLEMS
-MORBIDITY STATISTICS IN 2002 ALSO SHOWED THAT HYPERTENSION AND
DISEASES OF THE HEART ARE AMONG THE TOP TEN LEADING CAUSES OF
ILLNESSES IN THE COUNTRY.
-THESE DISEASES ARE LINKED BY THREE MAJOR RISK FACTORS:
1.TOBACCO SMOKING
2.PHYSICAL INACTIVITY
3.UNHEALTHY DIET
-THE RESULT OF THE NATIONAL NUTRITION AND HEALTH SURVEY CONDUCTED
IN 2003 CONCLUDED THAT PRESENTLY 90% OF FILIPINOS HAS ONE OR
MORE RISK FACTORS ASSOCIATED W/ CHRONIC, NON-COMMUNICABLE
DISEASES.
-A MAJOR STRATEGY TO PREVENT THESE DISEASES IS
HEALTH PROMOTION.
-ADDRESSING THE MAJOR RISK FACTORS SHOULD BE
GIVEN THE HIGHEST PRIORITY IN THE PREVENTION
AND CONTROL OF LIFESTYLE RELATED DISEASES.
HEALTHY LIFESTYLE-IS OPERATIONALLY DEFINED AS A
WAY OF LIFE THAT PROMOTES AND PROTECTS HEALTH
AND WELL-BEING.
HEALTHY LIFESTYLE:
-INCLUDE PRACTICES THAT PROMOTES HEALTH SUCH
AS HEALTHY DIET AND NUTRITION, REGULAR AND
ADEQUATE PHYSICAL ACTIVITY AND LEISURE,
AVOIDANCE OF SUBS., ADEQUATE STRESS
MANAGEMENT AND RELAXATION, AND PRACTICES
THAT OFFER PROTECTION FROM HEALTH RISKS LIKE
SAFE SEX AND IMMUNIZATION.
APPROACHES TO CHARACTERIZE THE PROGRAM(NCD’S)

1.Comprehensive Approach Focused on Primary

Prevention
-includes:
a.Prevention of emergence of risk factors
referred to as primordial prevention
b.Specific protection from NCD by removal of the
risk factors or reduction in their levels.
2. COMMUNITY-BASED APPROACH
-COMMUNITY-BASED NCD PREVENTION AND CONTROL PROGRAM
RECOGNIZES PEOPLE AS THE CENTER OF ANY HEALTH AND DEVELOPMENT
EFFORT.
-KEY INGREDIENTS TO SUCCESSFUL AND SUSTAINABLE COMMUNITY-BASED
HEALTH INITIATIVES:
1.ACTIVE COMMUNITY PARTICIPATION
2.INVOLVEMENT OF COMMUNITY LEADERS, COMMITTEES, AND GROUPS
3.STRONG SUPPORT AND GUIDANCE FROM LOCAL GOVERNMENTS AND
TECHNICAL EXPERTS
4.MULTI-SECTORAL COLLABORATION
3. INTEGRATED APPROACH
-A HEALTHY COMMUNITY CONTRIBUTES TO THE SOCIO-ECONOMIC
DEVELOPMENT OF THE COMMUNITY.
KEY INTERVENTION STRATEGIES:
1.ESTABLISHING PROGRAM DIRECTION AND INFRASTRUCTURE-COMMUNITY
DIAGNOSIS, ESTABLISHING A TEAM
2.CHANGING ENVIRONMENTS-ESTABLISHING PARTNERSHIP AND
INTERSECTORAL COORDINATING MECHANISM
3.CHANGING LIFESTYLE-RAISING PUBLIC AWARENESS THROUGH MASS
MEDIA AND OTHERS.
4.REORIENTING HEALTH SERVICES-HEALTH SERVICE DELIVERY
THE ROLE OF PUBLIC HEALTH NURSE IN NCD PREVENTION AND
CONTROL
1.Health Advocate
-PHN promote active community participation in NCD
prevention and control through advocacy work.
-involves in informing the people about the rightness of the
cause (problem);discussing with the people the nature of
the alternatives, their content and consequences;
supporting people’s right to make a choice and to act on
the choice; imnfluencing public opinion.
2. HEALTH EDUCATOR
-HEALTH EDUCATION IS AN ESSENTIAL TOOL TO ACHIEVE
COMMUNITY HEALTH
-CONCERNED WITH PROMOTING HEALTH AS WELL AS
REDUCING BEHAVIOR-INDUCED DISEASE.
-HEALTH EDUCATION FOCUSES ON ESTABLISHING OR
INDUCING CHANGES IN PERSONAL AND GROUP ATTITUDES
AND BEHAVIOR THAT PROMOTE HEALTHIER LIVING.
-AIMS TO:
1.INFORM THE PEOPLE
2.MOTIVATE THE PEOPLE
3.GUIDE PEOPLE IN ACTION
3. HEALTH CARE PROVIDER
-EMPHASIS OF CAREIS ON HEALTH PROMOTION AND DISEASE
PREVENTION FOCUSING ON PROMOTION OF RATIONAL DIET AND
PHYSICAL ACTIVITY AND CESSATION OF SMOKING AND
ALCOHOL DRINKING.
-IN THE DOMAIN OF CLINICAL MEDICINE, SEEKS TO RELIEVE
PAIN, ARREST OR CURE THE DISEASE AND PREVENT DISABILITY
AND DEATH
THROUGH PROVISION OF ACTIVITIES.
4. COMMUNITY ORGANIZER
-THE ULTIMATE GOAL OF THE PHN IS COMMUNITY HEALTH
DEVELOPMENT AND EMPOWERMENT OF THE PEOPLE.
5. HEALTH TRAINER
-PROVIDES TECHNICAL ASSISTANCE IN THE ASSESSMENT OF
SKILLS OF AUXILLARY WORKERS
6. RESEARCHER
-CONDUCTS COMMUNITY ASSESSMENTS, EPIDEMIOLOGICAL
STUDIES, AND INTERVENTION STUDIES
II. CAUSES AND RISKS FACTORS OF MAJOR NCD’S

Five major NCDs:

A. Diseases of the Heart and Blood vessels(CVD)
1.Hypertension-major risk factor for dev’t.of coronary
heart dse and stroke
Classification:
a.Primary-also called essential hpn or idiopathic hpn. 90%
of hypertensives.
b.Secondary-result of other primary dses like renal dse.
RISK FACTORS:
1.FAMILY HISTORY-TWICE AT RISK THAN THOSE WITH NO
HISTORY
2.AGE-OLDER PERSONS ARE AT GREATER RISK
3.HIGH SALT INTAKE-ELEVATION IN BLOOD VOL.
4. OBESITY-TWO TIMES GREATER AMONG OVERWEIGHT/OBESE
5.EXCESSIVE ALCOHOL INTAKE-REG.CONSUMPTION OF THREE
OR MORE DRINKS PER DAY LEAD TO HPN.
KEY AREAS FOR PREVENTION OF HYPERTENSION

 Proper nutrition-reduce fat and salt intake

 Prevent overweight or being obese-exercise,
nutrition
 Smoking cessation-tobacco use leads to
atherosclerosis
 Identify people with risk factors and encourage
reg.check-ups
2. CORONARY ARTERY DISEASE(CAD)

 Also known Ischemic Heart Disease

 Caused by impaired coronary blood flow
 Can cause MI,arrhthmias, heart failure, and sudden
death
 Most common cause is atherosclerosis or thickening of
the inside walls of arteries due to deposition of a fat-like
subs.
RISK FACTORS OF CAD:
1.ELEVATED BLOOD LIPIDS/CHOLESTEROL
-HIGH LDL(LOW-DENSITY LIPOPROTEIN)LEVEL IS A RISK FACTOR
OF CAD
-BAD CHOLESTEROL
HDL-PROTECTIVE FACTOR
2.SMOKING/TOBACCO USE
-RISK OF DEATH FROM CAD IS 70-200 TIMES GREATER FOR MEN
THAN THOSE WHO DO NOT SMOKE.
-RISK IS MOST SEEN 50 YEARS OLD BELOW.
KEY AREAS OF PREVENTION OF CAD

 Reg.exercise and physical activity

 Proper nutrition

 Maintain body weight

 Smoking cessation

 Early diagnosis, prompt treatment and control

3. CEREBROVASCULAR DISEASE OR STROKE (CVA)

 Insufficient supply of blood to the brain.

 Leading cause of disability
 Three types based on cause:
-thrombotic stoke
-embolic stroke
-hemorrhagic stroke
The most fatal is due to intracerebral hemorrhage
RISK FACTORS:
1.INCREASING AGE
2.SEX
3.HEREDITY AND RACE
4.HYPERTENSION
5.CIGARETTE SMOKING
6.DIABETES MELLITUS
7.HEART DISEASE
8.HIGH RED BLOOD CELL COUNT
9.SEASON AND CLIMATE
10.SOCIOECONOMIC FACTORS
11.EXCESSIVE ALCOHOL INTAKE
12.CERTAIN KINDS OF DRUG ABUSE
KEY AREAS FOR PREVENTION OF STROKE

 Tx or control of hpn
 Smoking cessation
 Appropriate medications to prevent thrombus
formation
 Limit alcohol consumption
 Avoid IV drug abuse and cocaine
 Prevent other risk factors of atherosclerosis
B. CANCER
 Not a single disease
 Many types of cancers as there are many types
of tissues in the body
 Develops when cells in a part of the body begin
to grow out of control
 Immune system play a role in devt.of cancer
CAUSES OF CANCER/RISK FACTORS
 Heredity/family history
 Carcinogens
 Chemicals and environmental agents-polycyclic
hydrocarbons found in cigarette smoke, smoked foods,
industrial agents.Aflatoxin in peanuts.
 Benzopyrene-smoked fish
 Nitrosamines-preservative foods like tocino. Inhibit Vit.C in
the stomach.
 Radiation
 Viruses
RISK FACTORS OF CANCER
 Include persons age, sex, and family medical history
 Different kinds of Cancer:
1.Lung cancer
2.Oral cancer
3.Laryngeal cancer
4.Bladder cancer
5.Renal cancer
6.Cervical cancer
7.Esophageal cancer
8.Breast cancer
9.Prostate cancer
10.Liver cancer
11.Skin cancer
12.Colonic cancer
13.uterine/endometrial cancer
KEY AREAS FOR PREVENTION OF CANCERS

 Smoking cessation
 Proper nutrition

 Alcoholic beverages in moderation

 Control obesity

 Treatment begins once diagnosed.

C. DIABETES MELLITUS
 One of the leading causes of disability in persons over
45.
 More than half of diabetic persons will die of coronary
heart disease
 DM is not a single disease.
 Characterized by glucose intolerance
 Etiology/causes: 2 factors:
-genetics(diabetogenetic genes)
-environment/lifestyle
TYPES:
1.IDDM
2.NIDDM
GESTATIONAL DIABETES
KEY AREAS:
-MAINTAIN BODY WEIGHT
-PROPER NUTRITION
-REGULAR PHYSICAL ACTIVITY/EXERCISE
-SMOKING CESSATION
D. CHRONIC OBSTRUCTIVE PULMONARY DISEASE9COPD)

-major cause of chronic morbidity and mortality throughout the

world
-fourth leading cause of death in the world-because of
smoking
-characterized by airflow limitation that is not fully reversible
-causes-cigarette smoking
-diagnosis-symptoms and spirometry
-complications-respiratory failure
Cardiovascular dse
E. BRONCHIAL ASTHMA
 Chronic disease
 Inflammatory disorders of the airways with wheezing,
breathlessness, chest tightness, coughing.
 Causes/risk factors:genetic and environmental
components
 Triggers are risk factors for asthma exacerbations.
Provoke bronchoconstrictions. Causal factors are
allergens and occupational agents
KEY AREAS FOR PREVENTION AND EXACERBATION OF
ASTHMA

 Recognizes triggers
 Avoid these triggers

 Promote exclusive breastfeeding as possible

II.RISK ASSESSMENT AND SCREENING PROCEDURES

 The basis of non-communicable disease

prevention is the identification of the major
common risk factors and their prevention and
control.
RISK FACTOR ASSESSMENT
 A. Cigarette Smoking-smoker or not
 B. Nutrition and diet- having 24-hour food diary w/c
includes vegetables, fruits, fats, sodium taken. Guideline:
 C. Overweight/Obesity-getting the BMI(Body Mass Index)
and waist circumference.
-weighing is the simplest way of knowing if
energy balance is achieved.
BODY MASS INDEX(BMI)
 Is calculated using this formula: BMI= weight in kgs/height in
meters
 Waist circumference(WC)-is accurate measure of the amount of
visceral fat. Remember that central obesity is a significant risk
factor to heart disease and stroke.
 Obesity guidelines:
CLINICAL THRESHOLDS:
 Men<90cm(35 inches)
 Women<80cm(31.5 inches)

-greater than this is not normal.

Degree of Risk on Body Mass Index and Waist Circumference:
Waist Hip Ratio(WHR)-another useful measure of obesity
obtained by dividing the waist circumference at the
narrowest point by the hip circumference at the widest
point.
FORMULA: WHR
 WHR=waist circumference(cm)
____________________
hip
Circumference(cm)
WHR interpretation:
 D. Physical inactivity/Sedentary lifestyle-type
of work, means of transportation, lesure.
 Guideline:

 E. Excessive alcohol drinking-habitual

alcohol intake and risky behavior
SCREENING
 According to WHO, it is the presumptive identification of unrecognized
disease or defect by the application of tests, examination or other
procedures which can applied rapidly.
 Primary goal is to detect the disease in its early stages to be able to
treat it and prevent further development.
 DOH name this lifestyle diseases like CVD and hypertension, DM,
cancer, COPD,asthma.
 A. Screening for hypertension-systolic of
140mmhg or more and diastolic of 90mmhg.
-most accurate and reliable is auscultatory
method. Mercury or aneroid BP apparatus.
B. Screening for elevated cholesterol in the blood
-taking a small blood sample and testing for total
blood cholesterol.
 C. Screening for Diabetes Mellitus
-hallmark of dx is presence of hyperglycemia.
-FBS
-2 hour blood sugar test
D. Screening for cancer
-early detection and prompt tx
-CURE RATE- depends on the type of cancer
-CAUTION US-cancer warning signals
 E. Screening for COPD
-characteristic symptoms:
-cough
-sputum production
-dyspnea upon exertion
Spirometry-det.degree of obstruction
F. Screening for Asthma
-hallmark is demonstration of reversibility of airway
obstruction.
-suspect asthma of cardinal sxs like dyspnea, cough,
wheezing, chest discomfort
ROLE OF THE PUBLIC HEALTH NURSE IN RISK ASSESSMENT AND
SCREENING

 Educate on the warning signs

 Educate to prevent NCD

 Assessment of the presence of risk factors and early signs of NCD

 Train other health workers

If risk factors are present:

 Confirm/advise retesting

 Explain the significance of findings

 Educate to modify risk factors

 Monitor and ff-up schedule

 Refer for confirmation of diagnosis

IV. PROMOTING PHYSICAL ACTIVITY AND EXERCISE

 Physical activity-done at home like washing dishes,

sweeping, cleaning the house
 Exercise-planned, structured, and repetitive
movement done to improve or maintain one or
more components of physical fitness. Like walking,
jogging, aerobics.
ROLE OF PUBLIC HEALTH NURSE

 Has the responsibility of increasing their

knowledge and skills needed to engage in
physical activities and exercise and motivate
them to be physically active.
V. PROMOTING PROPER NUTRITION

 Eating a balanced diet

 Nutrition-related problems that lead to NCD:

-obesity
-increased fat intake
-increased salt intake
-inadequate dietary fiber
STRATEGIES TO PROMOTEVHEALTHY-NUTRITION-
RELATED PRACTICES

ABC:
 Aim for ideal body weight

 Build healthy nutrition-related practices

 Choose foods wisely

Nutritional guidelines for Filipinos

ROLE OF PUBLIC HEALTH NURSE

 Educate on a balanced and healthy diet

 Assess for weight problems and unhealthy
practices
 Screen
 Advise and counsel
 Make referrals
 Advocate for a supportive environment
VI. PROMOTING A SMOKE-FREE ENVIRONMENT

 Smoking is the most common of all major factors that lead to

the dev’t of NCD’s.
 Development of smoking-related diseases are associated with:

-no.of cigarettes smoked

-duration of smoking
-age started smoking
-pattern of inhaling
 Harmful substances in Tobacco:
-tar
-nicotine
-carbon monoxide
Tobacco contains more than 4000 chemicals,
43 of w/c have been proven carcinogenic.
Quitting can reduce risk.
ROLE OF THE PUBLIC HEALTH NURSE

 Assisting smokers to quit

 Promoting a smoke-free environment
VII. PROMOTING STRESS MANAGEMENT
 Stress management techniques:
-spirituality
-self-awareness
-scheduling: time management
-siesta-taking a nap, short rest, a break for relaxation
-stretching
-sensation techniques
-sports
-socials
-sounds and songs
-speak to me
-stress debriefing
-smile
II. PROGRAMS FOR THE PREVENTION AND CONTROL OF OTHER NON-COMMUNICABLE
DISEASES

 National prevention of blindness program

 Vision/mission,goals and objectives
 Interventions by eye disorder:
-cataract
-errors of refraction
-childhood blindness
MENTAL HEALTH AND MENTAL DISORDERS

 WHO define mental health as a state of well-being where a

person can realize his or her own abilities to cope with normal
stresses of life and work productively.
 Four facets of public health burden:

-burden, undefined burden, hidden burden, future burden

NCMH-acute cases
 Nursing responsibilities and functions:
-mental health promotion
-in prevention and control
-rehabilitation
-in research and epidemiology
Pointers for having mental health
RENAL DISEASE CONTROL PROGRAM(REDCOP)

 National Kidney and Transplant Institute(NKTI)-

main implementing agency
 Kidney diseases:
COMMUNITY BASED REHABILITATION PROGRAM

 Creative application of the PHC approach in rehabilitation services for

persons w/ disabilities.
 Involves measures.

 Program components:

-social preparations
-services preparation
-training
-information education and communication
-monitoring, supervision, and evaluation
LEGAL BASIS
 Republic Act No.7277, otherwise known as the
Magna Carta for Disabled Person provides
rehabilitation, self-development, and self-reliance
of disabled persons. This act ensures full
participation of non-government organization and
other private factors.