Disease Burden Archives - InnoHEALTH magazine

Rising burden of non-communicable diseases

InnoHEALTH Magazine — Thu, 03 May 2018 11:13:40 +0000

The contribution of most of the major non-communicable disease groups to the total disease burden has increased all over India since 1990, including cardiovascular diseases, diabetes, chronic respiratory diseases, mental health and neurological disorders, cancers, musculoskeletal disorders and chronic kidney disease.

On the other hand, the DALY rates of stroke varied across the states without any consistent pattern in relation to the stage of epidemiological transition. This variety of trends of the different major non-communicable diseases indicates that policy and health system interventions to tackle their increasing burden have to be informed by the specific trends in each state. Increasing but variable burden of injuries among states.

The contribution of injuries to the total disease burden has increased in most states since 1990. The highest proportion of disease burden due to injuries is in young adults. Road injuries and self-harm, which includes suicides and non-fatal outcomes of self-harm, are the leading contributors to the injury burden in India. The range of disease burden or DALY rate varied 3 fold for road injuries and 6 fold for self-harm among the states of India in 2016. There was no consistent relationship between the DALY rates of road injuries or self-harm versus the stage of epidemiological transition of the states. The burden due to road injuries was much higher in males than in females. The DALY rate for self-harm for India as a whole was 1.8 times higher than the average globally for other geographies at a similar level of development in 2016.

The report says the disease burden due to child and maternal malnutrition has dropped in India substantially since 1990; this is still the single largest risk factor, responsible for 15% of the total disease burden in India in 2016.

This burden is highest in the major EAG states and Assam, and is higher in females than in males. Child and maternal malnutrition contributes to disease burden mainly through increasing the risk of neonatal disorders, nutritional deficiencies, diarrhoeal diseases, lower respiratory infections, and other common infections. As a stark contrast, the disease burden due to child and maternal malnutrition in India was 12 times higher per person than in China in 2016.

Kerala had the lowest burden due to this risk among the Indian states, but even this was 2.7 times higher per person than in China.

This situation after decades of nutritional interventions in the country must be rectified as one of the highest priorities for health improvement in India. Unsafe water and sanitation improving, but not enough yet Unsafe water and sanitation was the second leading risk responsible for disease burden in India in 1990, but dropped to the seventh leading risk in 2016, contributing 5% of the total disease burden, mainly through diarrheal diseases and other infections. The burden due to this risk is also highest in several EAG states and Assam, and higher in females than in males.

The improvement in exposure to this risk from 1990 to 2016 was least in the EAG states, indicating that higher focus is needed in these states for more rapid improvements.

Remarkably, the per person disease burden due to unsafe water and sanitation was 40 times higher in India than in China in 2016. The massive effort of the ongoing Swachh Bharat Abhiyan has the potential to improve this situation. Improvement was notice in household air pollution. Outdoor pollution worsened air pollution and remained high in India between 1990 and 2016, with levels of exposure among the highest in the world.

It causes burden through a mix of non-communicable and infectious diseases, mainly cardiovascular diseases, chronic respiratory diseases, and lower respiratory infections.

The burden of household air pollution decreased during this period due to decreasing use of solid fuels for cooking, and that of outdoor air pollution increased due to a variety of pollutants from power production, industry, vehicles, construction, and waste burning. Household air pollution was responsible for 5% of the total disease burden in India in 2016, and outdoor air pollution for 6%. The burden due to household air pollution is highest in the EAG states, where its improvement since 1990 has also been the slowest.

On the other hand, the burden due to outdoor air pollution is highest in a mix of northern states, including Haryana, Uttar Pradesh, Punjab, Rajasthan, Bihar, and West Bengal. Control of air pollution has to be ramped up through inter-sectoral collaborations based on the specific situation of each state.

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Menace of Non-Communicable diseases: A far reaching impact

InnoHEALTH Magazine — Wed, 28 Mar 2018 08:49:26 +0000

Non-communicable diseases (NCDs) represent a major peril to the economic growth and development and human health of any nation. The economic loss to India is pegged at $4.58 trillion before 2030 due to NCDs and mental health. The vicious cycle of high out-of-pocket expenditure on health, poor economic growth, workforce productivity loss and rising disease burden are intricately linked to the rising menace of NCDs.

The South Asian region─with a population of more than 1.7 billion─is experiencing a marked demographic transition─characterised by declining birth and death rates and an increasingly aging population. This increase in longevity has also been accompanied by a rise in the prevalence of NCDslike diabetes (78 million cases in 2015). India has the second highest number of diabetic patients in the world, at about 69 million, after China, and this figure is likely to reach 140 million by 2040 and almost half of them remain un-diagnosed. A recent study showed that seven out of ten diabetics in India – especially those in the 20-24 age group – do not take enough steps to control their blood sugar level – even after diagnosis.

The Economic Impact of Diabetes, As per a study conducted by the Indian Institute of Public Health, the number of diabetes patients in the country is likely to go up to 120 million in next 20 years as against the current 70 million. On an average a diabetic patient spends about INR 25,000 annually to manage the disease and its associated complications. Beyond placing a financial strain on the patient due to treatment expenditures, poor management of diabetes significantly impacts the patients’ quality of life: it may lead to loss of productivity due to multiple hospital visits, elevating rates of absenteeism, diminishing the energy and focus of a productive workforce, and depleting critical workplace skills ultimately leading to reduced mobility and span of life. Diabetes related complications like kidney failure, nerve damage along with obesity, dyslipidemia and hypertension make diabetes management quite complex for clinicians.

In this context, it becomes important that healthcare professionals have access to more educational resources to remain updated about how to tackle the diabetes epidemic. But due to scarcity of time and high patient load in South Asian healthcare facilities, medical practitioners find it very difficult to update their knowledge. Remaining updated can help clinicians offer better diabetes management options to their patients.

A Possible Solution: E-Learning Courses e-Learning programs can help clinicians in acquiring skills required to address the growing complex management of diseases. E-learning courses can be tailored to fit the clinicians schedule, delivering content right at the moment when it is demanded by the doctor. Interactive e-learning programs also offer peer to peer learning, thus enabling clinicians to discuss learning from key cases. Those e-learning programs which also offer the opportunity of contact classes, offer a richer and immersive learning experience.

An effective e-learning program will incorporate guidelines for determining the correct and appropriate blend of instructional strategies, including on-line learning, face-to-face instruction, and skill demonstrations, thus facilitating the learning of a clinician far beyond than traditional learning materials. Unlike traditional CMEs, e-learning can be designed to be self-paced, and research has indicated that e-learning reduces the learning time by at least 25-60% when compared to traditional learning, which can be an added advantage for time-constrained clinicians.

Intelligent e-learning management systems also adapt and learn from the learners’ aptitude and change and deliver a personalized learning experience. The right mix of video, audio, and text content formats help to ensure that delivery of content is mapped to the medium most appropriate & relevant to concept development.

Keeping in mind these perspectives, a Six Months Certification Course in Diabetes in partnership with Fortis C-DOC Hospital was launched by BMJ in South Asia. This course is endorsed by the Royal College of Physicians. This is a six months online learning course offered in two formats: with hands-on training and online-only – to cater to the learning needs of clinicians in South Asia.

Courses such as these will go a long way in knowledge & skill upgradation for clinicians in areas which the country faces a high disease burden. Such courses are clinician-centric and learner-led, and have been developed keeping in mind the real and on-ground challenges faced by doctors in South Asia.

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Read all the issues of InnoHEALTH magazine:
InnoHEALTH Volume 1 Issue 1 (July to September 2016) – https://goo.gl/iWAwN2
InnoHEALTH Volume 1 Issue 2 (October to December 2016) – https://goo.gl/4GGMJz
InnoHEALTH Volume 2 Issue 2 (April to June 2017) – https://goo.gl/Nv3eev
InnoHEALTH Volume 2 Issue 4 (October to December 2017) – http://amzn.to/2B2UMLw
InnoHEALTH Volume 3 Issue 1 (January to March 2018) – https://goo.gl/fksdQx

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