This document provides an overview of non-communicable diseases (NCDs) presented by the Epidemiology Department Group 2 at Bahir Dar University in Ethiopia. It defines NCDs and describes their global, regional, and national distribution. It analyzes patterns of the top five NCDs (cardiovascular disease, cancer, diabetes, chronic respiratory disease, and mental illness) that account for high mortality and morbidity worldwide. It also examines the impact of NCDs on life expectancy and healthy life years lost. Some key points include: NCDs are increasing rapidly in low and middle-income countries and are responsible for over 85% of deaths globally. The largest risk factors for early death and disability are now

1. Diseases of
Non-communicable Diseases
By
Epidemiology Dep’t Group 2
1 Bahir Dar University, Ethiopia
November 11, 2019
College of Medicine and Health Sciences
School of Public Health
Department of Epidemiology and Biostatics

2. Group members
 Getenet Dessie (BSc,MSc)
 Amsalu Worku (MD,Assistant professor in obey/gyn)
 Biniyam Teshome (MD,FCS Orthopedic Surgeon)
 Temesgen Assefa (MD,Assistant professor in internal
medicine)
 Waltenigus Guadie (MD,Assistant professor in obey/gyn)
 Yihun Miskir (BSc, Assistant professor in EMCCN)
 Minyichil Birhanu (BSc,MSc)
 Tadios Lidetu (BSc)
 G/Medihin Getu (BSc)
 Ayalew Kassie (BSc)
2

3. Presentation outline
 Objectives
 Epidemiology of NCD
 Distribution and pattern of tope five non
communicable diseases (CVD,CA,DM,CRD&MI
 Impact of non-communicable diseases on life
expectancy
 Summary
3

4. Non communicable Diseases
Objectives
 To define NCD
 To describe global, regional and national distribution of non-
communicable diseases
 To analysis global, regional and national pattern of tope five
non communicable diseases that accounts for high mortality
and morbidity across the globe
 To analysis the impact of non-communicable diseases on life
expectancy
YLL
DALYs
4

5. Method of accessing informations
 Electronic web-based search of PubMed,,CINHAL,
EMBASE, SCOPUS, African Index Medicus, lancet
and African Journals
 For PUBMED advance search, Medical Subject Headings
(MeSH terms) were used to help expand the search strategy.
 We built a search strategy by using the Boolean operator
separately and/or in combination of keywords
5

6.  Chronic conditions that do not result from an
(acute) infectious process and hence are “not
communicable.”
• A disease that has a prolonged course, that does
not resolve spontaneously, and for which a complete
cure is rarely achieved.
 Tunstall-Pedoe, 2006
Definition of NCDs
6

7.  Complex etiology (causes)
 Multiple risk factors
 Long latency period
 Non-contagious origin (noncommunicable)
 Prolonged course of illness
 Functional impairment or disability
 (Capps, 2001).
Nature & Characteristics of NCDs
7

8.  Cardiovascular disease (e.g., Coronary
heart disease, Stroke, HPN)
 Cancer
 Chronic respiratory disease
 Diabetes
 Mental illness
 account for the majority of deaths and
disabilities (Gouda et al., 2019; WHO, 2018).
Types of NCDs
8

9. Epidemiology of NCDs
 Before :- The “diseases of modern life”
 Currently:- they are becoming the leading causes of
morbidity and mortality in many developing countries
too >85%
 Health challenges of the 21st century.
 Epidemiologic transition in many developing countries
 (Capps, 2001).
9

10. Epidemiology of NCDs…..
 Epidemiologic
transition starts since
the end of World War II
 Antibiotics ,
 Vaccines,
 along with improved
living standards,
sanitation, nutrition,
and safe water,
(Capps, 2001).
10

11. Epidemiology of NCDs…..
11

12. Major NCDs responsible for deaths
Globally from all global deaths
31%7% 16%
12
3%
57%
Cancers
Diabetes
(Kisa & Collaboration, 2019).

13. “The World Health Report 2016”85
%
4%
22% 44%
9
%
Respiratory diseases
Cancers
Diabetes
“The World Health Organization Report 2016”
Five major NCDs responsible for deaths
Globally from all NCDS
3
%
Mental illness
13

14. Epidemiology of NCDs…..
Figure 1: DALYs for non-communicable diseases by age and sex, 2017
14

15. Epidemiology of NCDs…..
 75% of premature adult deaths (occurring in those aged 30–69
years) were caused by NCDs
 NCDs are not solely a problem for older populations.
 The probability of premature death among adults due to NCD:-
 Eastern Mediterranean 24%
 South-East Asian 23% regions
 African 22%
 Americas (15%),
 European (17%)
 Western Pacific (16%) regions.
 The risk of dying from any one of the four main NCDs for those
aged 30–69 years, decreased from 22% in 2000 to 18% in 2016
(Moraga & Collaborators, 2017).
15

16. Epidemiology of NCDs…..
 In all WHO regions, the probability of dying from a
NCD was greater for males than for females (Moraga &
Collaborators, 2017).
 From income level perspective a clear relationship is
evident
 In 2016, 78% of all NCD deaths, and 85% of premature
adult NCD deaths, occurred in low- and middle-
income countries
 NCD related premature deaths in developed country
(25%) ; low-income (43%) and lower-middle-income
(47%) countries (Moraga & Collaborators, 2017).
16

17. Epidemiology of NCDs…..
Figure 1: proportion of NCD death occurring among those aged 30-69 years, by income group,
2016.
17

18. Epidemiology of NCDs…..
Figure 1 : Proportion of NCD death occurring among those aged 30-69 years, by WHO region,
2016.
18

19. Non communicable diseases in sub-
Saharan Africa
 Between 1990 and 2017, the total number of DALYs due
to NCDs for all ages increased rapidly in the region
 From around 90·6 million to 151·3 million, representing a
67·0% increase.
 Of the total burden of disease, the proportion of NCDs
contribution on total DALYs increased from 18·6% to
29·8%
 (Gouda et al., 2019).
19

20. NCDs in sub-Saharan Africa ………………
 CMNN diseases declined Vs High NCD burden increase
 The growth in population size was the key driver of NCD
burden over this period
 The age-standardized DALY rate due to NCDs (21 757·7 DALYs
per 100 000 population is now almost equivalent to that for
CMNN diseases (26 491·6 DALYs per 100 000 population
[25 165·2–28 129·8]
(Gouda et al., 2019).
20

21. NCDs in sub-Saharan Africa ………………
 The increase in total DALYs due to NCDs can be largely explained
by the population growth and in lesser extent, by population
ageing (Gouda et al., 2019).
 Only in southern sub-Saharan Africa were changes substantially
explained by an ageing population.
 Zimbabwe and Lesotho, have seen rapid increases in NCD burden
in terms of both absolute DALYs and DALY rates, in contrast to
other countries in sub-Saharan Africa, where age-standardized
DALY rates have decreased (Gouda et al., 2019).
21

22. NCDs in sub-Saharan Africa ……
22
Burden of non-communicable diseases by country in sub-Saharan Africa,
2017(GBD,20176)

23. NCDs in sub-Saharan Africa ………………
 Compared with global estimates, sub-Saharan Africa had a
high burden of NCDs overall in 2017 (Gouda et al., 2019).
Figure 1: Burden of NCD globally and by sub-Saharan African region, 2017.
23

24. NCDs in Ethiopia
 Successful in reducing deaths related to CMNN diseases and
injuries by 65%,
 However, NCD join to be the leading causes of premature
mortality and death rates in 2015 (Misganaw et al., 2017).
Figure 1: National Proportional Mortality of NCDs in Ethiopia, 2018 (Organization, 2018).
16%
7%2%
2%
9%
9%
Proportion of mortality due to non comunicable diseases
Cardiovascular disease
Cancers
Respiratory disease
Diabetes
Injuries
Other NCD
24

25. NCDs in Ethiopia………..
1990–2015
Deaths due to
NCDs declined by
37% ( Misganaw et
al., 2017)
Despite incensement of the prevalence of NCD in Ethiopia,risk of premature death due to NCDs
is decreasing from 2000 to 2025 WHO, 2018 .
Figure1 : Trend of risk of premature death due to NCDs in ethiopia,2018(WHO, 2018)
25

26. Global trends in healthy life expectancy early
death and disability explained by NCDs
 Globally, in 2017, life expectancy was 73 years, but
healthy life expectancy was only 63 years.
 This means on average 10 years of life were spent in poor
health in 2017.
 This is mainly due to the trend of communicable and non-
communicable diseases.
(Metrics & Evaluation, 2018).
26

27. life expectancy and NCDs……
Figure 7: life expectancy at birth for both sexes across the region,
2017.
27

28. life expectancy and NCDs……
 The next two decades will see dramatic changes in the
health needs of the world's populations.
 Developing regions (four-fifths of the planet's people
live)
 Non-communicable diseases such as depression
and heart disease are fast replacing traditional
enemies;
 infectious diseases malnutrition, as the leading
causes of disability and premature death (A. D. Lopez & C. C.
Murray, 1998).
28

29. life expectancy and NCDs……
 In 2020, NCD are expected to account for seven out of every ten
deaths in the developing regions, compared with less than half
today.
 GBD 2016 ; out of the top 10 causes of death 3 were accounted due
to non-communicable diseases and this toll is expected to
increases to 8 in 2040 (Metrics & Evaluation, 2018).
 In all regions the rapidity of change, will pose serious challenges
to health-care systems scarce resources allocation (A. D. Lopez & C. C.
Murray, 1998).
29

30. 30
Antibiotics,s
anitati,good
nutrition
MCH
Death
by
CMN
N
by
41%.
death by
NCDs by 40%
• Population growth
• Aging population
• Sedentary life style
• Irresponsible
feeding
• Late dx
• Poor self care
adherence
(Metrics & Evaluation, 2018).
Vs
life expectancy and NCDs……

31. 31

32. 32

33. World map showing the probability of dying early from chronic
disease between 30 and 70 years of age
Most nations falling short of targets to cut
early deaths from chronic disease in 2018
by Ryan O'Hare ,2018
33

34. Global trends in risk factors leading to
early death and disability…….
Figure 1: Leading causes of early death, 2016 and 2040†(Metrics & Evaluation, 2018)
34

35. Life expectance and NCDs in Ethiopia
 NCDs are estimated to account for 30% of total deaths in 2014
 the probability of dying between ages 30 and 70 years from the 4
main NCDs is 15% (WHO,2014).
 NCD causes ,42% death;27% premature
 DALYs ; below 20% in 1990 to 69% in 2015 (Fassil
Shiferaw,2018)
 .
Figure 1: Premature mortality due to NCDs from 2000-2012, Ethiopia.
35

36. The five major non communicable
diseases
1. Cardiovascular diseases
 38% causes of non-communicable diseases (NCDs) worldwide
(WHO, 2017).
 Globally, Cardiovascular disease is the cause for an estimated
death of 17 .3 million people every year & this amount is likely to
rise to 23.6 million by the end of 2030 (WHO, 2017)
 Eastern Europe with highest estimated age-standardized
prevalence of IHD in 2015),
 Followed by Central Asia and then Central Europe. Eastern sub-
Saharan Africa, the Middle East/North Africa region, and South
Asia (2,000 prevalent cases per 100,000) ("Roth GA et al, 2017)
36

37. Global Distribution of the Burden of
Cardiovascular Diseases in 2015
37
Source: American College of Cardiology web page

38. Lauren Wilson,2013
38

39. Cardiovascular diseases in Africa
 In 2013, an estimated 1 million deaths were
attributable to CVD in sub-Saharan Africa ( 5.5% of all
global CVD related deaths , and 11.3 % of all deaths in
Africa.
 Almost two fold increases in prevalence of CVD have
been reported since 1990.
 This dramatic change in the profile of CVD in Africa
can be directly linked to population dynamics &
epidemiologic transition ("Cardiovascular disease in Africa
:epidemiological profile and challenges," 2017).
39

40. Cardiovascular diseases in Ethiopia
 Ischemic Heart disease & Stroke are the 5th & 6th leading cause
of death in Ethiopia as of 2018 ("CDC - Ethiopia report on leading
causes of diseases in Ethiopia, August 2019,")
 Prevalence of cardiovascular disease is rising in incidence
,prevalence & as a cause of death.
 From 2014 to 2016), cardiovascular disease is the commonest
cause of mortality among Non-communicable diseases ("National
strategic Action plan for prevention & control of Non Communicable Diseases in
Ethiopia ,2014 -2016,")
40

41. 2.Cancer
 Globally, the odds of developing cancer during a
lifetime (ages 0-79 years) were 1 in 3 for men and 1
in 4 for women .
 In 2017, skin; tracheal, bronchus, and lung (TBL);
and prostate cancers (the most common),
accounting for 54% of all cancer cases among men.
 For women in 2017, the most common incident
cancers were nonmelanoma skin cancer , breast
cancer, and colorectal cancer, accounting for 54%
of all incident cases (Kisa & Collaboration, 2019).
41

42. Epidemiology
 The largest increase in cancer incident cases between
2007 and 2017 occurred In middle SDI countries with a
52% increase
 changing age structure contributed 24%,
 population growth 10%
 In the lowest SDI quintile, population growth is the
major contributor
 In high SDI countries, increased incidence is mainly
driven by population aging
 (Kisa & Collaboration, 2019).
42

43. Age specific incidence rate
43
Figure 10: Average Annual Percentage Change in Age-Standardized Incidence Rate in
Both Sexes for All Cancers from 2007 to 2017.

44. Age specific mortality rate
44

45. Cancer incidence and mortality based
on SDI
45

46. Cancer incidence and mortality based on SDI
46

47. Cancer in Ethiopia
Incidence of the three commonest cancers in men across different
age categories in Ethiopia, 2015 (Memirie et al., 2018)
47

48. Cancer in Ethiopia
Incidence of the three commonest cancers in women
across different age categories Ethiopia,2015
(Memirie et al., 2018
48

49. 3.Diabetes
49
Figure 1: Ten countries with the largest number of adults with diabetes in 1980 and 2014.

50. Worldwide distribution of diabetes ….
50
Figure 1: trends in prevalence of diabetes, 1980–2014, by country income group (Roglic, 2016).

51. Trends in the number of adults with diabetes
by region
51
Figure 1: Trends in the number of adults with diabetes by region (A) and decomposed into the
contributions of population growth and ageing rise in prevalence, and interaction between the
two (B).

52. Diabetes in Ethiopia
 In 2016, overall diabetes prevalence among male
and female was 4.0% and 3.6% respectively (WHO,
2016).
52
Figure 1: Trends in age-standardized prevalence of diabetes in Ethiopia,2016 (Organization,
2016).

53. 4.Chronic respiratory diseases
 In 2015, 3.2 million people died from COPD
worldwide, an increase of 11.6% compared with 1990.
 From 1990 to 2015, the prevalence of COPD
increased by 44.2%
 In 2015, 0.40 million people (0.36 million to 0.44
million) died from asthma
 The prevalence of asthma increased by 12.6% (9.0 to
16.4), 17.7% (15.1 to 19.9) (Soriano et al., 2017).
 However age-standardized prevalence decreased for
both diseases
53

54. Age-standardized DALY due to asthma
54
Figure 1: Age-standardized DALY rate per 100 000 people due to asthma, by country, both
sexes, 2015

55. 5.Epidemiology of mental illness
 Mental illness comprised 13% of the total global burden
of disease in 2000 – a figure that is expected to rise to
15% by the year 2020. (Heron MP,2018)
 Between 35% and 50% of people with severe mental
health problems in developed countries; 76 – 85% in
developing countries, receive no treatment.
 Mental health problems are a growing public health
concern (Saxena S, 2014).
55

56. Epidemiology of mental
illness…..56
WHO,2018

57. Disability-adjusted life years (DALYs)
distribution by country (%)
57
WHO,2018

58. Mental illness epidemiology in Africa
 Mental health problems appear to be increasing in
importance in Africa.
 Between 2000 and 2015 the number of years lost to
disability as a result of mental and substance use
disorders increased by 52%.
 In 2015, 17·9 million years were lost to disability as a
consequence of mental health problems.
 Such disorders were almost as important a cause of
years lost to disability as were infectious and
parasitic diseases, which accounted for 18·5 million
years lost to disability (WHO Global Health Estimates 2016
58

59. Mental illness epidemiology in
Ethiopia
 The average prevalence of mental disorders in
Ethiopia was 18 % for adults and 15% for children.
 Families now do not need much agitation to seek
medical help for their mentally ill members.
 By consequence, a large number of the adolescent is
homeless, and lives on the street
 (Sathiyasusuman A. 2011).
 rural area of Ethiopia comprised 11% of the total
burden of disease, with schizophrenia and
depression
 (Fdroemo H. 2015/16.).
59

60. Summary
 NCDs are global health and socio-economic threat
both in developing and developed countries
 Becomes High in developing countries
Growth and aging of populations;
 it needs sustainable multi-sectoral intensive efforts
and resources to achieve the target goals.
60

61. 61

62. Acknowledgement
Dr. Achenef Motbainor (BSc,MPH,PhD)
Author of all findings
62

63. 63