COMMUNITYHEALTH PROMOTION


DISEASE PREVENTION AND CONTROL
 Specific Objectives

1. Define and identify non-communicable diseases

common in the community 
2. Describe the control and preventive measures of non-
communicable diseases
 Definition
Non communicable diseases (NCDs),


They are not passed from person to person.

They are of long duration and generally slow in

progression.
 Non-communicable diseases are largely preventable by
eliminating shared risk factors, mainly tobacco use,
unhealthy diet, physical inactivity and the harmful use of
alcohol
 TYPES OF NCDs
The four main types of non-communicable diseases are:-


 cardiovascular diseases (like hypertension)
Cancers
 chronic respiratory diseases (such as chronic obstructed
pulmonary disease and asthma)
Diabetes
Epilepsy
Mental disorders
This session will cover Diabetes, cardiovascular
diseases, Cancers and chronic respiratory diseases
 Diabetes
 Insulin is a chemical produced by the pancreas which acts


like a key that opens the body cells for sugar to enter so
that it can be used for energy production. When cells do
not take up sugar it overflows and floods the blood
system, this is referred to as high blood sugar
 Diabetes mellitus is a disease that is characterized by high
sugar in the blood resulting from: defects in secretion of a
hormone called insulin, insulin inaction or both.
 D Cont’d..
Simple classification of D

Type 1 
 Occurs in young children and adolescents.

It results from damage to the pancreas which leads in

failure of insulin production.
Accounts for up to 10% of all cases of diabetes.
D Cont’d..
Type 2


It is the commonest type of diabetes accounting for up to
90% mostly in adults.
It is due to reduced insulin production or resistance of
body cells to insulin, or both.

Gestational Diabetes
Diabetes detected for the first time during pregnancy.

It occurs due to failure of the body to make and use all the
insulin it needs for pregnancy.
 Pre-diabetes state

 state where an individual has abnormally high blood


sugar that has not reached levels categorized as diabetes.
 People with pre-diabetes are at risk of developing
diabetes or getting complications before overt diabetes
sets in.
 Signs and Symptoms of Diabetes
 Frequent urination

 Excessive thirst

 Extreme hunger

 Unexplained weight loss

 Increased fatigue

 Irritability

 Blurry vision

 Impotence-failure to sustain an erection.


 Risk factors for Diabetes
 Advancing age.



Family history of diabetes
Overweight and Obesity
 Excessive alcohol consumption
 Physical inactivity.
 Stress.
 Unhealthy diet.
 pregnancy
 Birth weight of 5kgs or more
 Chronic use of steroids
 Prevention and Control of DM
 Promotion of healthy diets

 Promotion of physical activities

 Maintenance of Healthy weight

 Avoidance of alcohol and tobacco products

 Early detection and treatment of increased blood sugar

level to prevent complications of diabetes.
 Community and institutional support for people with
long term complications of diabetes
 Treatment of Diabetes
 Treatment entails diabetes education, proper nutrition,
physical activity, weight control and cessation of smoking

and excessive alcohol intake plus diabetes drugs.
 On education, people with diabetes and their families
need to know;
•Diabetes is serious chronic disease, has no cure, but
can be controlled
•Complications are not inevitable (they can be
prevented)
•Regular medical checkups are essential
•When to seek medical help (tbd)
 Cardiovascular Disease (CVD)
Refers to a group of disorders of the heart and blood vessels
and include;

Coronary heart disease (CHD) – disease of the blood
vessels supplying the heart.
Cerebrovascular disease (CVD) “Strokes”– disease of the
blood vessels supplying the brain
Peripheral vascular disease (PVD) - disease of blood
vessels supplying the arms and legs that can lead to death of
tissues in legs due to poor circulation
 CVD Cont’d…
 Hypertension- a symptom associated with many


cardiovascular diseases. It presents with an elevated
blood pressure.
 • Persistent hypertension is one of the risk factors for
stroke, myocardial infarction, heart failure and arterial
aneurysm, and is a leading cause of chronic kidney
failure
 Impact of CVDs

 CVD affects people in their mid-life years, undermining


the socioeconomic development, not only of affected
individuals, but families and nations.
 They are very expensive to treat and thus prevention and
control is the most feasible option to reduce their impact.
Risk factors of Common Cardiovascular Diseases
 The most important behavioral risk factors of heart disease
and stroke are;

 unhealthy diet,

 Physical inactivity

 Harmful use of alcohol

 tobacco use.

 Behavioral risk factors are responsible for about 80% of

coronary heart disease and cerebrovascular disease.
 Symptoms of Cardiovascular Diseases
Symptoms of a heart attack include:
Pain or discomfort in the centre of the chest

Pain or discomfort in the arms, the left shoulder, elbows,
jaw, or back.
Difficulty in breathing or shortness of breath;

Feeling sick or vomiting;

 Feeling light-headed or faint;

Breaking into a cold sweat; and

Becoming pale.
 Symptoms of CVD Cont’d..

symptom of a stroke is;


 sudden weakness of the face, arm, or leg, most often on
one side of the body.
Sudden onset of numbness of the face, arm, or leg,
especially on one side of the body; confusion, difficulty
speaking or understanding speech; difficulty seeing with one
or both eyes; difficulty walking, dizziness, loss of balance or
coordination; severe headache with no known cause; and
fainting or unconsciousness.
 Prevention of Common CVDs
 Eat a heart-healthy diet (give examples)

 Exercise regularly, at least 30 minutes a day.


 Stop smoking tobacco products

 Stop or limit alcohol consumption

 Limit the amount of sodium (salt)

 Manage stress

 Maintain a healthy body weight

 Regular medical check up to detect early signs and

 Cancer
Definition of Cancer

It is the name for diseases in which the
body’s cells become abnormal and divide
without control
Cancer cells tend to grow uncontrollably
invading neighbouring tissues and
eventually, spreading to other areas
through the bloodstream and lymphatic
system
Normal vs Cancer Forming cells

Ruth Muia : NCI-K

 Body parts Commonly affected by Cancer

 Breast
  Colon/rectum
 Cervix  Skin
 Food pipe  Lung
 Prostate  Blood
 Stomach  mouth(oral)

 ?Other body parts

Ruth Muia : NCI-K

 Common Body Parts affected bycancer

Esophageal cancer Esophageal cancer

Breast cancer
Stomach cancer
Stomach cancer
Colorectal cancer
Cervical cancer
Prostrate cancer

Ruth Muia : NCI-K

 Cancer burden in Kenya


 Cancer is the 3rd leading cause of death in Kenya

 6 out of 10 patients are below 70 years

 About 8 in every 10 of patients are diagnosed at the

advanced stages

Ruth Muia : NCI-K

 Common cancers in Kenya

 Cervical cancer  Kaposi sarcoma cancer

 Prostate cancer  Non Hodgkin cancers

 Oesophageal cancers
Childhood cancers
 Breast cancer
o Retinoblastoma
 Colorectal cancers
o Leukaemia burkitts
 Oral cancer o Lymphomas
 Cancer Progression

 Cancer starts from one cell or a group of cells that


multiply abnormally and spread to other tissues and
organs
 Staging of cancer is based on the size of the cancer
and extent to which the disease has spread

Ruth Muia : NCI-K

 Cancer Staging


Early stage/Stage 1: Cancer is small and localised in one area,
It's the early stage of the disease
Stage 2 and 3: Cancer has grown and spread to the nearby
tissues or lymph nodes
Stage 4: Cancer disease has spread to other parts of the body
Cancer can progress from stage 1 to later stages
If detected and treated early, it increases the
chances of cure
NB: Incase of late diagnosis, care and treatment is
offered to control the disease

Ruth Muia : NCI-K

 Signs and symptoms of common cancers

Breast cancer 
 Unexplained breast lumps

 Nipple discharge

 Inverted nipple

 Ulceration on the breast

 Enlarged lymph nodes in the armpit and

neck
Ruth Muia : NCI-K
Breast cancer images


 Cervical cancer

 Vaginal discharge 
 Vaginal bleeding(irregular or post menopausal)

 Post coital pain

 Foul smell

Ruth Muia : NCI-K

Cervical cancer image

Ruth Muia : NCI-K

 Prostate cancer


 Difficulty starting and maintaining a steady urine
stream
 Dribbling of urine

 Frequent urination especially at night

 Blood in urine or semen

Ruth Muia : NCI-K

Prostate cancer image

Ruth Muia : NCI-K

 Colorectal cancer

 Blood in stool

 Change in bowel habits

 Abdominal pain/discomfort

Ruth Muia : NCI-K

Colorectal cancer images

Ruth Muia : NCI-K

 Oesophageal cancer

 Pain or difficulty in swallowing

 Worsening indigestion or heart burn

 Voice hoarseness

 Unexplained weight loss

Oesophageal cancer images


 Risk factors for common cancers

 Non modifiable risk factors

 Behavioral/Modifiable factors

 Infections

 Environmental and occupational

 Non-modifiable Risk factors


These are risk factors that we have no control over

1.Gender

2.Age

3.Family history

4.Personal history of cancer

 Behavioral/modifiable risk factors


These are risk factors associated with lifestyle that
can contribute to cancer
1.Use of tobacco and tobacco products
2.Use of alcohol
3.Unhealthy diets
4.Lack of physical activity
Lifestyle modification


 Infectious Diseases and cancer

 Certain cancers have been linked to certain infections

 Examples:

• Human papilloma virus (HPV) - Cervical cancer

• Hepatitis B & C - Liver cancer

 Environmental risk factors


1. Outdoor air pollution

2. Household air pollution ( poor ventilation)

3. Soil and water pollution with certain pesticides or cancer

causing chemicals

4. Food contamination with aflatoxin (due to poor storage of

grains)
 PREVENTION EXAMPLES


 Cervical cancer is 100% preventable because:
o The cause is known - Human Papilloma virus (HPV)
o It progresses slowly from precancer stage to cancer
 Prevention is through:
o HPV vaccine – free for girls 10 years old
o Screening for women aged 25-49 years
o Treatment of precancer & cancer
Ruth Muia : NCI-K
 Prevention Examples

Other cancers for mass screening:
 Breast cancer: for women over 40 years

 Colorectal cancer – through checking for blood

in stool
 EARLY DETECTION

Leads to better treatment

outcomes, less morbidity & lower
treatment costs
Ruth Muia , National Cancer
07/14/25 46
Institute of Kenya (NCI-K )
 
Remember the children too !
 Common Childhood Cancers


 Retinoblastoma

 Leukemia (blood cancer)

 Burkitt’s lymphoma

Ruth Muia : NCI-K

 Retinoblastoma

Manifestation 
Opacity in the eye(white pupil)

Swelling on the eye

NB: There are many childhood cancer and most are not
amenable to screening, however early detection is
possible
Retinoblastoma image

Ruth Muia : NCI-K

.
 Epilepsy
 Chronic brain disorder of various aetiologies characterized
by repetitive ,sudden onset, short-lived seizures occurring

more than twice in a year and unprovoked by any
identified cause.
 Common terms associated with epilepsy in the
community;
 Kifafa
 Convulsions
 Seizures
 Fit
 Attack
 Causes of Epilepsy
Some of the common causes of epilepsy include:
 Brain Infections


Meningitis
Cerebral malaria.

 HIV and AIDS –opportunistic infections.
 Lack of oxygen to the brain;
 lack of oxygen to the brain at birth/asphyxia
 Structural brain problems.
 Hydrocephalus. –accumulation of fluid in the baby’s head
 Tumours/growths in the head
 Abscesses
 Causes of Epilepsy Cont’d..
 Genetic/ Hereditary causes

 Trauma 
 Head injury-e.g. RTA, assault

 Birth trauma e.g. big head of baby in a mother with a small

pelvis(CPD), baby falling
 Myths associated with epilepsy

 Epilepsy is contagious (getting into contact with the


body secretions of an epileptic person during an attack)
 You can swallow your tongue during a seizure

 Epilepsy is a product of witchcraft

 Epilepsy is a form of mental illness

 Epilepsy is a permanent disorder

 People with epilepsy look different

 Triggering Factors

Conditions include;

 Sleep deprivation 
Non-adherence to treatment.{suddenly stopping}

 Acute infections
 Flickering of lights
 Alcohol intake /withdrawal
 Hormonal imbalances e.g. seizures during menstruation
 Dehydration
 Emotional Stress
 Excessive physical exercise
 Classification of Epilepsy

Epilepsy can be classified into two major types:


1.Partial: seizures result from abnormal activity in just one
part of the brain with either impairment or retention of
consciousness

2.Generalized: Seizures due to a widespread involvement

of large parts of the brain simultaneously leading to loss of
consciousness.
 Signs and symptoms of epilepsy

 Temporary confusion

 A staring spell 
 Uncontrollable jerking movements of the arms and legs

 Loss of consciousness or awareness

 Seizure Emergency Checklist
1. Do not restrain - it can make the seizure more severe
2. Stay nearby.
3. Speak kindly.

4. If the person is moving around, remove dangerous, sharp or hot
objects from the area.
5. Stand behind the person and gently guide him or her away from
danger.
6. If the person shakes or falls, turn the head or whole body to the
side so that saliva can drain from the mouth.
7. Force nothing between the teeth. A hard object can increase
damage to the tongue from biting, and a soft object can become
lodged in the throat, causing suffocation.
8. When the seizure is over, let the person rest then consult a health
care worker
 Principles of Management of Epilepsy
 Community awareness to demystify epilepsy and reduce
stigma on epilepsy to facilitate presentation of patients for
treatment.

 Teach those close to the patient on how to react in the
event of a seizure.
 Prompt referral and follow-up of persons with signs of
epilepsy for confirmation of diagnosis.
 Strict compliance and adherence to the treatment regimen
prescribed.
 Gradual drug withdrawal should be considered if the
patient has been seizure free for the last 2 – 3 years.
Roles of CHVs in prevention and
control of NCDs

 Give messages on prevention and control
 Community mobilization for NCDs screening
 Referral for screening
 Follow up of affected persons and their
families
 References
1. AMREF (June 2009). A facilitator Guide for training Community
Health Committees. Kenya (Unpublished)

2.

Ministry of Health (2011) Integrated Curriculum for Training
Community Health Workers in Kenya.Nairobi: Government of
Kenya

3. Ministry of Health (2007).Manual for Training Community

Health Extension Workers, Kenya. Unpublished.

4. Ministry of Health (2011). Curriculum for Community Health

Committees in Kenya
 References Cont’d…
1. Canadian Public Health Association (1996). Action Statement


for Health Promotion in Canada

2. Participants at the 6th global conference on Health Promotion,

the Bangkong Charter for Health Promotion in a globalized
world, Geneva Switzerland,WHO,2005

3. Constitution of WHO (1996). International Health Conference

New York.

4. Drunker, P. F (1999) innovations and entrepreneurship

 References Cont’d…
1. CARROLL, J., HORNING, M., HOFFMAN, B., GANOE, C.,
ROBINSON, H., ROSSON, M. (2012) Visions, Participation and

Engagement in New Community Information Infrastructures.The
Journal of Community Informatics, North America, 7, Nov.
2011. Date accessed: 14 Sep.

2. 2012.Entrepreneurship in Rural America,” Rural

Entrepreneurship Initiative. Chapter 9, p. 1.3/Smilor, Raymond
W. “Entrepreneurship and Community Development,” Kauffman
Center for Entrepreneurial Leadership. 1997, p. 8.

3. 10. http://www.cdc.gov/malaria/about/biology/. Center for

disease control