IEC

NON-COMMUNICABLE DISEASES
– LIFESTYLE RELATED DISEASES

WILMA N. BERALDE, RM, RN, MAN

NDP – Balatan
Non – Communicable Disease Coordinator
 Cancer

NCD
Diabetes
Mellitus
Cardio
vascular Lifestyle
Diseases
Related
Diseases
Chronic
Respirator
y Diseases
Accidents
& Injuries
4 MAJOR NCDs IN THE PHILIPPINES

• CARDIOVASCULAR DISEASES
• CANCERS
• CHRONIC OBSTRUCTIVE PULMONARY
DISEASES
• DIABETES MELLITUS
Epidemiology of the Major NCDs

 The Philippines is one of the 23 selected

countries contributing to around 80% of the total
mortality burden attributable to chronic diseases
in developing countries, and 50% of the total
disease burden caused by NCDs worldwide
(Lancet, 2007)
 Common Risk Factors Leading to Major NCDs
Chronic
Cardiovascular Diabetes
Risk Factors Cancers Respiratory
Diseases Mellitus Diseases
Smoking    

Diet/Nutrition    

Physical inactivity    

Obesity    

Alcohol   

Raised blood   
pressure
Raised blood sugar   

Abnormal blood   
lipids

* coronary artery disease, hypertension, stroke

**chronic obstructive pulmonary disease, asthma
Source: WHO STEPwise Approach to Surveillance of NCD Risk, 2003
 NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
ACCIDENTS &
CANCER HEART DISEASE LUNG DISEASE DIABETES
INJURIES

Cardiovascular Disease
• describes a range of diseases that affect the heart and blood vessels and includes:
Coronary Artery Disease

Myocardial Infarction

Congenital Heart Disease

Congestive Heart Failure

Hypertension

Stroke

Arrhythmias

others.
 Description of Major NCDs
Cardiovascular
–
diseases and their risk factors
Coronary artery diseases
• increased total cholesterol, high LDL,
low HDL, smoking,
obesity/overweight, physical
– Hypertension inactivity, diabetes
• Family history, age, high salt intake,
obesity, excess alcohol intake
– Cerebrovascular diseases • Age, sex, heredity, hypertension,
smoking, diabetes, heart disease, high
(stroke)
RBC, excessive alcohol intake, drug
abuse
 NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
ACCIDENTS &
CANCER HEART DISEASE LUNG DISEASE DIABETES
INJURIES

Physical
Inactivity &
Unhealthy Obesity High Blood
Diet (salts Sugar &
&  fats) Cholesterol

Smoking
Risk Genetically
Factors inherited
 HYPERTENSION
An increase in blood pressure ≥ 140/90 mmHg in two (2) or
more separate occasions.
One of the leading causes of disability among Filipinos due to
stroke.
BLOOD PRESSURE SYSTOLIC BP DIASTOLIC BP
CLASSIFICATION

NORMAL LESS THAN 120 mmHg LESS THAN 80

mmHg

PRE HYPERTENSION 120 - 139 mmHg 80 – 89 mmHg

Stage 1
Hypertension 140 – 159 mmHg 90 – 99 mmHg

Stage 2 160 mmHg or Higher 100 mmHg or

Hypertension higher

Classification of blood pressure for adults

 HYPERTENSION
RISK FACTORS
 Smoking
 Excessive alcohol consumption
 Overweight
 Family history of hypertension, heart disease, diabetes and kidney
disease
 Sedentary lifestyle
 Chronic stress
 Advancing age

PREVENTION
 Regular exercise and eating”heart healthy” diet
 Excessive alcohol consumption and cigarette smoking also
increases the likelihood of hypertension
 HYPERTENSION
USUAL SIGN AND SYMPTOMS
NOT ALL HYPERTENSIVE PATIENTS HAVE SYMPTOMS….
 Headache
 Dizziness
 Blurring of visions
 Nape/ neck discomfort
EARLY DETECTION IS AN IMPORTANT FACTOR FOR PREVENTING
FURTHER COMPLICATIONS……
POSSIBLE COMPLICATIONS
Chronic, undiagnosed and untreated hypertension may
result to:
Heart attack stroke kidney failure loss of vision
Lifestyle modification to prevent and manage
hypertension
LIFESTYLE RECOMMENDATION APPROXIMATE SYSTOLIC
MODIFICATION BP REDUCTION
Weight reduction Maintain normal body weight 5-20 mmHg
Adopt DASH eating Consume a diet rich in fruits, 8-14 mmHg
plan (dietary vegetables, and low fat dairy
Approach to stop products
hypertension)

Dietary sodium (salt) Reduce dietary sodium intake 2 – 8 mmHg

restriction
Physical activity Engage in regular aerobic physical 4 -9 mmHg
activity such as brisk walking (at
least 30 min per day, most days of
the week)

Moderation of Limit consumption to no more than 2 -4 mmHg

alcohol consumption 2 drinks per day in most men and
not more than 1 drink per day in
women and lighter weight persons
 NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
ACCIDENTS &
CANCER HEART DISEASE LUNG DISEASE DIABETES
INJURIES
Secondary to

DM
Body’s failure to
produce insulin decreased
and usually sets activity of the
in among the Type 1 Type 2 insulin produced
Diets high in which results in
young
population trans-fatty acids, Lack of increased blood
groups saturated fatty physical sugar level and
usually sets in
acids & glycemic activity among the older
load age groups

Obesity
(single
Smoking Risk most
important)
Factors
for DM
Type 2
Description of Major NCDs

Diabetes and its risk factors

– Diabetes • Family history, overweight, lack of

physical activity, hypertension,
HDL < 35mg/dl, triglyceride
>250mg/dl, history of gestational
diabetes, with impaired glucose
tolerance
 DIABETES
group of metabolic disorders
characterized by high blood sugar level
on 2 separate occasions

results when the body cannot properly

regulate the amount of sugar (e.g.
glucose in the blood)
 DIABETES
4 clinical types of diabetes
Type 1 : INSULIN DEPENDENT DIABETES
Type 2 : NON-INSULIN DEPENDENT DIABETES
who can be managed through oral anti-diabetic
medications but may eventually also require insulin
treatment to attain good blood glucose control
Type 3 : GESTATIONAL DIABETES
who were first diagnosed to have diabetes during pregnancy
Type 4 :SECONDARY DIABETES
acquired diabetes that may be drug or chemical-induced
such as those who are being treated for AIDS or from other
endocrine diseases such as hyperthyroidism.
Values for the diagnosis of diabetes and other categories of
hyperglycemia
Criteria for
Type of Testing FBS Values Classification Diagnoses of
Diabetes Mellitus
Fasting blood sugar 109 mg% Normal Any of the following:
(FBS) - no caloric intake 110- 125 mg% Impaired
for at least 8 hours glucose Symptoms of diabetes
which means no food, tolerance plus RBS> 200 mg/dL
juices, milk, but water is 126 mg% Possible (11.1 mmol/L)
allowed diabetes
mellitus FBS> 126 mg/ dL (7.0
2-hour blood sugar test: mmol)
performed after using
75 g glucose dissolved in 2-hr blood sugar >
water or after a good 200 mg/dL (11.1
meal mmol/L) during an
oral glucose tolerance
test (OGTT)*
* FPG estimation is the biochemical test of choice for screening in all age groups. In adults,
FPG measurement has been found to be more reproducible than the 2-hour plasma glucose
level following an OGTT.
**OGTT is the gold standard for diagnosing diabetes and can be used as a screening test.
 DIABETES
RISK FACTORS FOR DIABETES
 High blood pressure
 High triglyceride levels
 Giving birth to an 8 lb baby
 Sedentary lifestyle
 Obesity
 Family history of type 2 diabetes mellitus among 1st degree
relatives
USUAL S/S OF DIABETES
 Fatigue excessive urination
 Unexplained weight loss poor wound healing
 Excessive thirst Excessive hunger
 DIABETES
PREVENTION
 Diabetes , a lifestyle –related disease which can
be prevented through regular exercise (at least
30 min every other day) and eating a “heart
healthy” diet (i.e. low -salt ,low-fat diet)

 Excessive alcohol consumption and cigarette

smoking also increases the likelihood of
diabetes
 NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
ACCIDENTS &
CANCER HEART DISEASE LUNG DISEASE DIABETES
INJURIES

Unhealthy
diets
Excessive Physical
Alcohol inactivity &
consumption Obesity

Environmental and

Smoking
Risk occupational
exposures to
Factors carcinogenic
substances
Guidelines for Common Screening
Procedures for Major NCDs

Cancer warning signs

Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in the breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in warts or moles
Nagging cough or hoarseness in voice
Unexplained anemia
Sudden weight loss
 Description of Major NCDs
Some cancers and their risk factors
– Oral cancer • Smoking, excessive alcohol
use, chronic irritation, Vitamin
A deficiency
• Early menarche/late
– Breast cancer menopause, high fat diet,
obesity, physical inactivity,
alcohol, family history
• Smoking, radiation exposure
– Lung cancer • Smoking, HPV infection,
chlamydia infection, low
intake of fruits and vegetables,
family history
– Cervical cancer
 Guidelines for Common Screening
Procedures for Major NCDs
Screening guidelines for breast cancer
(targets 15-60 years old and above)
• Monthly breast self-examination
• Breast examination by health worker (annually) for all child-bearing
woman
• Annual mammography for women over 50 years old and above
• For certain high risk women, baseline mammography at age 35 with
repeat upon recommendation of attending physician
• Genetic screening and counseling for high risk patients or if
appropriate
• Referral to hospital for further management if found positive (+) for
mass or any abnormalities
Guidelines for Common Screening
Procedures for Major NCDs

Breast Self- Examination

Stand in front of a Clasp your hands

mirror. Check each behind your head and
breast for anything press hands forward.
unusual (dimpling, Check contour of
discharge). breast.
Guidelines for Common Screening
Procedures for Major NCDs

Breast Self- Examination

Gently squeeze each nipple While standing, raise one arm. Use
and look for discharge finger pads to check the breast and
surrounding area – firmly, carefully and
thoroughly.
Guidelines for Common Screening
Procedures for Major NCDs
Breast Self- Examination

Lines

Wedges Circles
Guidelines for Common Screening
Procedures for Major NCDs

Breast Self- Examination

Lie flat on your back, with one arm over your head and a
pillow or folded towel under the shoulder. This position
flattens the breast and makes it easier to check.
 Guidelines for Common Screening
Procedures for Major NCDs
Changes in the breast that should be noted and reported to a
physician
• Any lump or hard knot • Dimpling, skin irritation, or
found in the breast or other change in the breast
armpit skin or nipple
• Any lump or thickening of • Redness or scaliness of the
the tissue that does not nipple or breast skin
shrink or lessen aftr her • Discharge from the nipple
next period (fluid coming from the
• Any change in the size, nipples other than breast
shape, or symmetry of her milk), particularly if the
breast discharge is clear and
• A thickening or swelling of sticky, dark or occurs
the breast without squeezing the
• Any dimpling, puckering, or nipple
indention in the breast • Nipple tenderness or pain
 Guidelines for Common Screening
Procedures for Major NCDs
Screening guidelines for lung cancer

• Screening for lung cancer is still debatable since

clinical studies have failed to demonstrate a
significant reduction in lung cancer mortality as
a result of screening
• A number of tests can be done to look for
cancerous cells and to rule out other conditions:
– Chest x-ray – an X-ray image of lungs may reveal an abnormal mass or nodule.
– Chest CT scan - can reveal small lesions in lungs that might not be detected on an
X-ray.
– Sputum cytology – if patient has cough and producing sputum, microscopy of
sputum
 Guidelines for Common Screening
Procedures for Major NCDs
Screening guidelines for cervical cancer
• Cervical cancer is a disease in which the cells of the
cervix become abnormal and start to grow
uncontrollably, forming tumors.
• Early warning signs: often asymptomatic; may cause
abnormal vaginal bleeding (e.g. post-coital bleeding)
in some women
• Tests:
– Papanicolaou or Pap smear
– Visual inspection with acetic acid wash (VIA)
Guidelines for Common Screening
Procedures for Major NCDs
Screening guidelines for cervical cancer
 Guidelines for Common Screening
Procedures for Major NCDs
Screening guidelines for cervical cancer
VISUAL INSPECTION WITH ACETIC ACID WASH
 Instruct client not to douche or use any type of
lubricant and refrain from intercourse for at least 24
hours prior to exam

 Assume lithotomy position

 Inspect the vulva and vagina for any signs of

abnormalities

 Gently insert bivalve speculum (moistened with warm

water/saline) halfway and rotate 45 degrees clockwise
until the cervix comes into view.

 Once visualized, lock speculum in open position.

 Guidelines for Common Screening
Procedures for Major NCDs
Screening guidelines for cervical cancer
VISUAL INSPECTION WITH ACETIC ACID WASH

 Inspect cervix with unaided eye

 Normally pink in color with smooth

surface.

 Cervical os is generally red, horizontal,

or oval opening usually about 0.5 cm
in size

NORMAL CERVIX
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 Guidelines for Common Screening
Procedures for Major NCDs
Screening guidelines for cervical cancer
VISUAL INSPECTION WITH ACETIC ACID WASH
 Place a large cotton swab immersed in 3%
acetic acid on the cervix for about 2
minutes.

 Inspect the cervix.

 Abnormal cervix areas would turn

whitish (fades in 5 minutes). Refer
immediately for colposcopy and Pap
smear.

 If normal, advise patiwent to have

another test within 1-5 years
POSITIVE AAT

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Guidelines for Common Screening
Procedures for Major NCDs
Screening guidelines for cervical cancer
MAMMOGRAPHY
 Guidelines for Common Screening
Procedures for Major NCDs
Screening guidelines for prostate cancer

• History taking
• Digital rectal examination (DRE)
Age to begin DRE Risk
Age 50 Males with average risk
Age 45 Males with higher risk; i.e., with first degree
relative with prostate cancer before age 65
years
Age 40 Males with highest risk; i.e., with multiple family
members diagnosed with prostate cancer
before age 65 years
Guidelines for Common Screening
Procedures for Major NCDs
Screening guidelines for prostate cancer
DIGITAL RECTAL EXAMINATION

• The male rectum can be

palpated with the patient
lying in a lateral position
or standing in hips flexed,
and leaning over a table.
 Guidelines for Common Screening
Procedures for Major NCDs
Screening guidelines for prostate cancer
DIGITAL RECTAL EXAMINATION
– With a gloved, lubricated index finger the
rectal examination is carried out in a
systematic manner beginning with the right
lateral surface and, then proceeding to the
posterior, left lateral and anterior surfaces.
• Note for size, nodularity and tenderness

Normal prostate is approximately 2x4x3 cm and

enclosed in a smooth capsule
 Guidelines for Common Screening
Procedures for Major NCDs

Screening guidelines for colorectal cancer

• For adults more than 50 years old, aanual fecal occult blood test and
flexible sigmoidoscopy every 5 years
• To be completely valid, the test must be repeated 3-6 times on
different samples.
• Consider that occult blood may appear in stool in diverticulities,
gastric carcinoma, and gastritis
• Drugs taken by clients should be considered because some drugs
such as salicylates, steroids, indomethacin, colchicines, iron and
rauwolfia derivatives are associated with increased gastrointestinal
blood loss in normal persons and even more pronounced bleeding
when disease is present
 Description of Major NCDs
COPD and Asthma and their risk factors
– COPD • Smoking

• Genetic predisposition,
allergens, smoking, air
– Asthma pollution, respiratory
infections
 NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
ACCIDENTS &
CANCER HEART DISEASE LUNG DISEASE DIABETES
INJURIES

Chronic Respiratory Disease

• The most common morbid conditions suffered by Filipinos are respiratory diseases.

Major causes of death Top leading

due to Respiratory Respiratory causes of
causes Morbidity
• Chronic Respiratory • Acute Respiratory
Diseases (Asthma, Infection
COPDs) • Acute Lower
• Pneumonia Respiratory Tract
Infection
• Pneumonia
• Bronchitis
 NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
ACCIDENTS &
CANCER HEART DISEASE LUNG DISEASE DIABETES
INJURIES
environmental
pollutants
(Allergens and
Noxious fumes)
Other Factors that
Tobacco may worsen
Smoking (single CRDs(stress, fatigue,
extreme temp.
most infection, humidity &
important) endocrine changes,
genetic predisposition

Risk
Factors
 NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
ACCIDENTS &
CANCER HEART DISEASE LUNG DISEASE DIABETES
INJURIES
 Accidents are unintentional, unexpected and undesirable
events while injuries are either intentional or unintentional
events that result in damage or harm to a person (DOH, 2005).
 Most accidents and injuries can be avoided.
 Their effects can be reduced through measures like road safety
education, installation of adequate walkways, streetlights, signages,
and home safety management.
 In high-income countries, road traffic injuries, self-inflicted
injuries and interpersonal violence are the three leading
causes of death among those aged 15 to 44 years.
 In the same age group, there are twice as many suicides and three
times as many traffic-related deaths as homicides.
 Key Areas for the Primary Prevention of the
Major NCDs

 Promote Proper Nutrition

 Encourage more physical activity and exercise
 Promote smoke-free individuals and environment
 Discourage excessive alcohol drinking
 Manage stress effectively
 Maintain regular health check-up
Key Areas for the Primary Prevention of the
Major NCDs

PROMOTE SMOKE-FREE INDIVIDUALS

AND ENVIRONMENT
• Smoking cessation for active smokers to reduce risk
• Prohibit smoking inside living areas, houses and closed areas
• Avoid smoke-filled places
• Advocate for implementation of policies that support smoke-
free environment
• Support policies/ordinances/laws that limit access of cigarettes
to children and youth
Key Areas for the Primary Prevention of the
Major NCDs

PROMOTE ALCOHOL-FREE ENVIRONMENT

• Discourage excessive alcohol drinking

• Regular health check-up for early diagnosis and prompt
treatment
Key Areas for the Primary Prevention of the
Major NCDs

PROMOTE PROPER NUTRITION

• Limit intake of fatty, salty and preserved foods

• Increase intake of vegetables and fruits
• Avoid high caloric low-nutrient value food like junk food, instant
noodles, soft drinks
• Start developing healthy habits in children
Key Areas for the Primary Prevention of the
Major NCDs

ENCOURAGE MORE PHYSICAL ACTIVITY

• Moderate physical activity of at least 30 minutes for most days

• Integrate physical activity and exercise into regular day-to-
day activities
• Promote walking as one form of exercise that is possible for all
including older persons and persons with cardiovascular
disease
Key Areas for the Primary Prevention of the
Major NCDs

PROMOTE A STRESS-FREE ENVIRONMENT

• Manage stress effectively

• Regular health check-up for early diagnosis and prompt
treatment
wilmarmrnman