Emergence Of Non-communicable Diseases Research Articles

Health risk factors, status and service utilisation of adults in primary health care settings in Qatar: The HEALTHSIGHT study protocol.

The emergence of non-communicable diseases (NCDs) has been well documented in recent literature which constitute a significant global burden of disease. Qatar which has a significantly high prevalence of NCDs with early on set. Epidemiological and health service utilization information plays a central role in facilitating informed decision making and application of the fundamental principles of PHC in planning and delivery of healthcare with aim to prevent and control NCDs. To enable this, the Department of Clinical Research at Primary Health Care Corporation (PHCC), Qatar's publicly funded and largest primary care provider designed the Health Assessment Linking Trends in Health Status, Risks, and Healthcare Utilization (HEALTHSIGHT) study. This paper describes the HEALTHSIGHT study protocol. The proposed study will use a cross sectional study design involving a random sample of participants enrolled across all 31 PHCC health centers. Individuals aged 18 and above years old registered with PHCC and hold a valid health card and contact information on PHCC's electronic medical records (EMR) will be eligible for inclusion. A stratified random sample not proportional to size sampling technique will be employed to obtain a representative sample size of the PHCC population (N = 6000). Participants will be scheduled for an appointment at a PHCC health centre where a data collector will obtain informed consent, collect vital sign information and administer a questionnaire. A phlebotomist will collect a blood sample. Health service utilization data will be extracted from PHCC's EMR. Epidemiological and health service utilization information is essential to plan and monitor primary care and public health services. The HEALTHSIGHT study, with the help of a randomly selected representative sample from Qatar's primary healthcare settings, provides a unique opportunity to capture this information. This study design will closely represent a real-world understanding of the health risk, status and utilisation and is likely to provide important data to guide primary care planning and delivery in Qatar. The proposed protocol provides an example of a robust nationwide study that be undertaken in short duration using limited resource which can be undertaken in other similar settings.

Emergence of Cardiovascular Diseases and Inclusive Organization of Care in the Health District of Biyem-Assi, Yaounde Cameroon

Healthcare financing is one of the major challenges that faces the emergence of non-communicable diseases. This study describes and analyzes the inclusive organization of cardiovascular disease care in Biyem-Assi Health District. From December 2022 to February 2023, we conducted a qualitative study in the Biyem-Assi Health District. Medical anthropology research techniques were used to collect data through interview guides. The sample consisted of patients admitted and followed during the study period. The epidemiological variables studied included age, sex, diagnosis, length of hospital stay, lifestyle, socioeconomic status, knowledge, and modalities of cardiovascular disease (CVD) management, as well as practices aimed at eradicating this scourge. Cardiovascular disease mortality is currently the highest. It affects a young population, so diagnosis is often made late. Very few international technical and financial partners have a real strategy to support prevention and management programs for non-communicable diseases, especially cardiovascular diseases. Faced with the growing incidence of cardiovascular diseases in sub-Saharan Africa, mainly in Cameroon, it is urgent to develop a response or rethink a new organization of cardiovascular disease care, involving and mobilizing numerous technical and financial partners, public authorities, and directly concerned healthcare professionals.

Beyond Pregnancy: Understanding the Long-Term Implications of Gestational Diabetes Mellitus

The term "gestational diabetes mellitus," or GDM for short, refers to a hyperglycemic state that is initially identified during pregnancy, usually in the second or third trimester. At the moment, it is the most typical pregnancy-related medical issue. Around 15% of pregnancies worldwide roughly 18 million newborns annually—are affected by GDM. Preterm delivery and high birth weights are two fetal complications. Pre-eclampsia, postpartum abnormal glucose intolerance, and gestational hypertension are risks associated with GDM. Furthermore, GDM mellitus raises the possibility of problems like heart disease, obesity, and impaired glucose metabolism, culminating in type 2 diabetes in both the mother and the child. More focus and knowledge are needed about the rising incidence of GDM, which carries a substantial financial cost. It becomes imperative to have an in-depth comprehension of the pathophysiology and risk factors, with a focus on the impact of GDM in the emergence of non-communicable diseases. Additionally, an efficient treatment plan may be necessary to lessen perinatal and metabolic problems. Diet and physical activity are the main therapy for GDM. To step up the treatment, metformin, glibenclamide, and insulin can be employed. Based on the literature, this study offers a summary of the most recent findings about the etiology, diagnosis, therapy, and epidemiology of GDM. The significance of a diagnosis of GDM is emphasized as a potential indicator of non-communicable disease (NCD) risk in the future. Additionally, the impact of proper GDM management during and after pregnancy on the risk of NCDs in the mother and her kids is highlighted. An electronic search was conducted using Google Scholar, PubMed, and Scopus. Included were published research from 2014 to 2023 that described the epidemiology, diagnosis, risk factors, and treatment of GDM. Keywords: Gestational diabetes, Maternal health, Fetal health, Hyperglycemia, non-communicable disease, Longterm outcomes

Psycho-Educational Program sebagai Strategi Peningkatan Partisipasi Lansia pada Program Prolanis di Puskesmas Tamalanrea Makassar

In Indonesia, the elderly with chronic illnesses have a relatively high percentage. According to the Basic Health Research (Riskesdas) results in 2018, data indicates an increase in non-communicable diseases such as diabetes, hypertension, and stroke among the elderly. The aging process in the elderly leads to a decline in physiological body functions, resulting in the emergence of non-communicable diseases in old age. The purpose of this community service activity is to enhance the knowledge of the elderly about chronic diseases (hypertension and type II diabetes) through a psycho-educational approach. The educational methods employed include lectures, counseling, and discussions. This activity took place on Friday, September 8, 2023, and was attended by 32 elderly individuals at the Tamalanrea Community Health Center who participated voluntarily. Based on observations, the majority of the elderly demonstrated good knowledge about chronic diseases after the question-and-answer sessions and discussions between the speakers and participants. It is hoped that through this activity, the community, especially the elderly, will gain a better understanding of chronic diseases (hypertension and type II diabetes), leading to behavioral changes and improved capabilities in identifying and preventing chronic illnesses in the future.

Influence of Adipose Tissue on Early Metabolic Programming: Conditioning Factors and Early Screening.

Obesity and being overweight have become one of the world's most severe health issues, not only because of the pathology but also because of the development of related comorbidities. Even when children reach adulthood, the mother's environment during pregnancy has been found to have a significant impact on obesity prevention in children. Thus, both maternal dietary habits and other factors such as gestational diabetes mellitus, excessive weight gain during pregnancy, smoking, or endocrine factors, among others, could influence newborn growth, adiposity, and body composition at birth, in childhood and adolescence, hence programming health in adulthood. The aim of this review is to analyze the most recent human studies on the programming of fetal adipose tissue to determine which modifiable factors may influence adiposity and thus prevent specific disorders later in life by means of a bibliographic review of articles related to the subject over the last ten years. The importance of a healthy diet and lifestyle not only during pregnancy and the first months of life but also throughout childhood, especially during the first two years of life as this is a period of great plasticity, where the foundations for optimal health in later life will be laid, preventing the emergence of noncommunicable diseases including obesity, diabetes mellitus type 2, hypertension, being overweight, and any other pathology linked to metabolic syndrome, which is so prevalent today, through health programs beginning at a young age.

Health problems associated to nutrition and lifestyle changes in the COVID-19 era

Introduction:In the context of the response to the COVID-19 pandemic, the confinement imposed by the States in the world had a negative impact on people’s health and lifestyle-related behaviors, particularly eating behaviors, physical activity level and sleep. These impacted dimensions can negatively affect both immunity and the control of chronic noncommunicable diseases. Objectives: This review describes the lifestyle change for people with non-communicable diseases in the era of COVID-19. The review also presents recommendations and advice for the benefit of this vulnerable population in relation to their nutrition. Methods:The research was conducted by documenting the PubMed, Web of Science and Direct Science databases. Keywords used in the research were non-communicable diseases, containment, COVID-19, lifestyle change. Results:Containment during the COVID-19 era was associated with increased smoking, physical inactivity, unhealthy eating, and intense fear of the potential impact of the Coronavirus.Conclusion:Strengthening immunity through the promotion of nutrition has been shown to be useful in preventing the emergence of noncommunicable diseases, which are risk factors linked to increased rates of morbidity and mortality for those infected by COVID-19.Keywords: COVID-19, confinement, immunity, chronic noncommunicable diseases, nutrition

Status and correlates of non-communicable diseases among children and adolescents in slum and non-slum areas of India's four metropolitan cities.

The emergence of non-communicable diseases (NCDs) in childhood poses a serious risk to a healthy adult life. The present study aimed to estimate the prevalence of NCDs among children and adolescents in slums and non-slums areas of four metropolitan cities of India, and in rural areas of the respective states The study further, investigated the effect of the place residence as slum vs. non-slum and other risk factors of the NCDs. Nationally representative data from the Comprehensive National Nutrition Survey (CNNS) was used.. Estimates were based on children (5-9 years) and adolescents (10-19 years) for whom biomarkers predicting diabetes, high total cholesterol, high triglycerides and hypertension were determined. Weight, height and age data were used to calculate z-scores of the body mass index. Overweight and obesity was higher in urban areas than in rural areas among children and adolescents. Regional differences in the prevalence of diseases were observed; children in Delhi and Chennai had a higher likelihood of being diabetic while children in Kolkata were at a greater risk of high total cholesterol and high triglycerides. The risk of hypertension was strikingly high among non-slum children in Delhi. Children from slums were at a higher risk of diabetes compared to the children from non-slums, while children and adolecents from non-slums were at a greater risk of high triglycerides and hypertension respectively than their counterparts from slums. Male children and adolecents had a higher risk of diabetes and high cholesterol. Screening of children for early detection of NCDs should be integrated with the already existing child and adolescent development schemes in schools and the community can help in prevention and control of NCDs in childhood.

Experience of Interventional Cardiology At CHU ''Luxembourg'' In Bamako

Introduction: In the recent past, it was not possible to treat coronary disease in Mali due to a lack of technical facilities. All our coronary patients were evacuated to the Maghreb, France or the sub-region to receive adequate care. In 2019, the opening of an interventional cardiology room at the University Hospital "Luxembourg" and the training of a team has allowed the local management of a good number of Malians and foreigners suffering from coronary pathology. We report here the results of 30 months of activities. Methodology: We performed a perspective analysis of coronary angiograms and angioplasties performed in our center from September 2019 to February 2022. Clinical, paraclinical including angiographic data were collected and analyzed. Results: Between September 2019 and February 2022, 670 patients underwent coronary angiography, 262 of whom were followed by angioplasty. Male gender was predominant (72.6%), a sex ratio of 2.62. The mean age was 59 years and the 46-65 age group was the most dominant (50.24%). High blood pressure was the main cardiovascular risk factor (33.8%). Chronic coronary syndrome was the most frequent indication (59.8%) followed by coronary syndromes (38.3%). The radial route was used in 98%. Coronary angiography was pathological in 69%. Multitruncular lesions were predominant (35.5%) followed by monotruncular (32.8%). 39.10% of our patients underwent angioplasty. Complications were minimal (3%) and mortality was 2.03%. Conclusion: In our developing countries, we are witnessing an epidemiological transition with the decrease in infectious diseases and the emergence of non-communicable diseases, particularly coronary diseases. Their management requires an adequate technical platform, qualified human resources, and multidisciplinary collaboratio

Risk of Chronic Disease after an Episode of Marasmus, Kwashiorkor or Mixed-Type Severe Acute Malnutrition in the Democratic Republic of Congo: The Lwiro Follow-Up Study.

Background: Long-term impact of different forms of severe acute malnutrition (SAM) in childhood on the emergence of noncommunicable diseases (NCDs) is poorly known. Aim: To explore the association between subtypes of SAM during childhood, NCDs, and cardiovascular risk factors (CVRFs) in young adults 11 to 30 years after post-SAM nutritional rehabilitation. Methods: In this follow-up study, we investigated 524 adults (mean age 22 years) treated for SAM during childhood in eastern Democratic Republic of the Congo (DRC) between 1988 and 2007. Among them, 142 had a history of marasmus, 175 of kwashiorkor, and 207 had mixed-form SAM. These participants were compared to 407 aged- and sex-matched control adults living in the same community without a history of SAM. Our outcomes of interest were cardiometabolic risk markers for NCDs. Logistic and linear regressions models were sued to estimate the association between subtype of SAM in childhood and risk of NCDs. Results: Compared to unexposed, former mixed-type SAM participants had a higher adjusted ORs of metabolic syndrome [2.68 (1.18; 8.07)], central obesity [1.89 (1.11; 3.21)] and low HDL-C (High-density lipoprotein cholesterol) [1.52 (1.08; 2.62)]. However, there was no difference between groups in terms of diabetes, high blood pressure, elevated LDL-C (low-density lipoprotein cholesterol) and hyper TG (hypertriglyceridemia) and overweightness. Former mixed-type SAM participants had higher mean fasting glucose [3.38 mg/dL (0.92; 7.7)], reduced muscle strength [−3.47 kg (−5.82; −1.11)] and smaller hip circumference [−2.27 cm (−4.24; −0.31)] compared to non-exposed. Regardless of subtypes, SAM-exposed participants had higher HbA1c than unexposed (p < 0.001). Those with a history of kwashiorkor had cardiometabolic and nutritional parameters almost superimposable to those of unexposed. Conclusion: The association between childhood SAM, prevalence of NCDs and their CVRFs in adulthood varies according to SAM subtypes, those with mixed form being most at risk. Multicenter studies on larger cohorts of older participants are needed to elucidate the impact of SAM subtypes on NCDs risk.

Prevalence and Risk Factors of Hypertension and Diabetes Mellitus among the Indonesian Elderly

Background: Epidemiological and demographic transitions lead to the emergence of non-communicable diseases (NCD) among the elderly. This study aimed to examine the risk factors of hypertension and diabetes mellitus (DM) among the elderly by using secondary data (Basic Health Research 2018). Methods: Secondary data from Basic Health Research (N = 88,911) were used. Cut-off values for measurement were WHO standard of 126 mg/dl for fasting and 200 mg/dl for non-fasting for DM and 140 mmHg for systole and 90 mmHg for diastole for hypertension. Univariate, bivariate, and multivariate (binary logistic regression) analyses were conducted using STATA version 15. Results: The prevalence of hypertension and DM among the elderly was about 22.30% and 5.39%, respectively. Age, sex, educational level, marital status, place of residence, and employment status were substantially associated with hypertension and were risk factors for DM. Conclusions: There is significant correlation between hypertension and DM are risk factors of one another and therefore show a relationship. Various sectors must develop appropriate programs, including community and family support, to address this situation.

Ramadan Fasting and NCDs-Example of the Diabetes.

Although Ramadan lasts only for 1 month each year, it can be accompanied by significant changes in: both energy and nutritional intake; in the diet composition; in the working hours; and the usual way of life. The majority of practitioners consume two meals, one after sunset (Iftar) and one before dawn (Sohor). During this month, it is also an opportunity to share a meal with family and friends, a period of highly intensified socialization. In parallel with the nutritional changes brought about by this unique pattern of fasting in Ramadan, other metabolic and physiological changes may occur, such as fluctuations in body weight and/or disturbance in the quantity and quality of the sleep-wake circadian rhythm. In the verses of the Qur'an, the exemption from fasting in certain situations such as illness is clearly stated. Despite this religious tolerance, many faithful who are eligible for the exemption observe the fast of Ramadan either for the spiritual aspect it provides by performing it, by religious guilt or to mark a normalization in the Muslim community for fear of the gaze of others. The world is experiencing an increase in the emergence of non-communicable diseases (NCDs); leading cause of the global mortality. Environmental and behavioral risk factors related to lifestyle, such as smoking, excessive alcohol consumption, unhealthy diet, and sedentarity have a causal association with NCDs. Other factors, such as genetic and physiological factors may also be associated (overweight, high blood pressure, dyslipidemia). Diabetes is one of the highest prevalent NCDs in the world and it continues increasing year by year. This chronic disease can lead to significant potential complications (degenerative, dermatological, and acute) to the patient's health. This requires an individual and appropriate care, both dietetic and therapeutic and over the long term will at best make it possible to sensitize the diabetic patient to the adverse effects related to his disease and thus improve its quality of life. Performing the Fast of Ramadan for a diabetic is a common situation. Diabetes is the only chronic disease widely studied in relation to Ramadan fasting. In the literature, many studies have investigated the effects of Ramadan intermittent fasting on diabetic patients. This article aims to provide a general overview and highlight if there are many effect of Ramadan fasting on diabetes, as an example of a NCDs.

Consequence of oil and Waste Spills on the Environment of Ogoniland, Rivers State, Nigeria

environmental degradation of the oil-rich niger delta region has been wanton and continuous with dire health, social and economic consequences for its peoples, for over three decades. Oil exploration and exploitation is very lucrative, and a major revenue earner in nigeria. But, like most industrial activities, it produces environmental hazards that are “slow poisons,” in that they often take months and years to cause disease and death. This is unlike the contamination of water, food, and the environment with micro-organisms, which immediately results in ill health. The covert and slow action of the hazards created by oil exploration and exploitation make it difficult to fully appreciate their contribution to the disease burden in nigeria, especially in the oil-bearing communities, even with the emergence of non-communicable diseases as major causes of ill health in nigeria. This paper addresses questions like: what challenges and impact will ogoniland face concerning spillage of oil and other wastes on its environment (water, vegetation, aquatic lifes, people and socio-economic lifes? Which are the spillage control measures to be adopted in ogoniland to obtain best production culture and consideration? It discusses the trend of oil spillage problem and possible antidote to it in the niger delta part of nigeria.

Consequence of oil and Waste Spills on the Environment of Ogoniland, Rivers State, Nigeria

environmental degradation of the oil-rich niger delta region has been wanton and continuous with dire health, social and economic consequences for its peoples, for over three decades. Oil exploration and exploitation is very lucrative, and a major revenue earner in nigeria. But, like most industrial activities, it produces environmental hazards that are “slow poisons,” in that they often take months and years to cause disease and death. This is unlike the contamination of water, food, and the environment with micro-organisms, which immediately results in ill health. The covert and slow action of the hazards created by oil exploration and exploitation make it difficult to fully appreciate their contribution to the disease burden in nigeria, especially in the oil-bearing communities, even with the emergence of non-communicable diseases as major causes of ill health in nigeria. This paper addresses questions like: what challenges and impact will ogoniland face concerning spillage of oil and other wastes on its environment (water, vegetation, aquatic lifes, people and socio-economic lifes? Which are the spillage control measures to be adopted in ogoniland to obtain best production culture and consideration? It discusses the trend of oil spillage problem and possible antidote to it in the niger delta part of nigeria.

Knowledge, attitude and practices pertaining to healthy lifestyle in prevention and control of chronic diseases: a rapid review

With the emergence of non-communicable diseases (NCDs), healthy lifestyle has become critical to not only reduce the burden of NCDs, but also to prevent complications and severity of these diseases. Knowledge, attitude and practices (KAP) pertaining to healthy lifestyle play an important role in determining the occurrence and progress of NCDs. KAP elements are interrelated and dependent on each other. While awareness campaigns provide necessary information to people on healthy lifestyle, how well this information is utilised is a grey area. The objective of this rapid review is to understand the relationship between KAP elements pertaining to healthy lifestyle among individuals who are at risk of developing NCDs and those who are living with NCDs. For this purpose, a rapid review of articles available on Google scholar and Pubmed was conducted. Articles focusing on KAP elements pertaining to healthy lifestyle from the year 2015-2021 were reviewed. Findings from the reviewed studies suggested that people have knowledge about the harmful effects of unhealthy diet, physical inactivity, tobacco and alcohol. People have a positive attitude towards healthy lifestyle, however, being knowledgeable and having a positive attitude did not translate into practicing healthy lifestyle due to multiple barriers to translate existing knowledge into practice. Since practice scores are poor among people, existing behaviour change strategies must be re-examined. An epistemological analysis of existing human behaviour with identified barriers and facilitators to adopt healthy lifestyle can help in formulating sustainable and effective social and behaviour change interventions.

Allocative Inefficiency of General Hospitals in Poor Countries: A Case Study of Uganda

The increasing costs of healthcare arising largely from the growing population and emergence of non-communicable diseases have exerted pressure on healthcare budgets in poor countries. With a funding gap of 7% to realize WHO recommended target of 15 percent of GDP in Uganda, there is a need for hospitals to be efficient in allocation of financial resources in order to provide the required level of healthcare services. Most studies on Uganda have focused on the technical inefficiency of general hospitals and evidence on their allocative inefficiency is limited. Understanding the sources of inefficiency in the allocation of finances in general hospitals in Uganda is important to improve their performance. The purpose of this study was to determine the allocative inefficiency of the general hospitals in Uganda in order to provide a source of misuse of public allocations to a particular general hospital. Panel data from 22 general hospitals for the period 1997-2007 were used. Allocative inefficiency was estimated using Stochastic Frontier Analysis. The findings show that general hospitals are systematically allocatively inefficient in distributing the public funds given to them. The allocative inefficiencies value is high on payments of employee benefits (34.8 percent), followed by the purchase of drugs (29.2%) and lastly, costs on utilities like electricity and water (14.1%). To address the existing allocative inefficiencies, general hospitals in Uganda can improve the process of hiring of labour and management of staff payroll; monitor procurement of drugs, and reduce wastages in the use of utilities.

La nutrición materna y la programación metabólica: el origen fetal de las enfermedades crónicas degenerativas en los adultos

Diversas investigaciones han demostrado que alteraciones nutricionales en las madres influyen para que los hijos padezcan enfermedades crónicas no transmisibles en la edad adulta. Estas enfermedades son patologías de lenta evolución y no contagiosas como las involucradas en el síndrome metabólico que incrementa el riesgo de padecer diabetes tipo 2 y enfermedades cardiovasculares. En esta revisión se analizan los conceptos de síndrome metabólico, programación metabólica fetal, epigenética, factores nutricionales (desnutrición y sobrealimentación) relacionados con alteraciones en el desarrollo temprano de los individuos que condicionan en la edad adulta la aparición de enfermedades crónicas no transmisibles. Por desgracia, las perspectivas sobre el panorama de una reducción en estas enfermedades tanto en México como en el resto del mundo son poco alentadoras.

Promoción de alimentación saludable en restaurantes: investigación cualitativa de estudio de casos colombianos

Introducción: La alimentación fuera de casa se ha identificado como uno de los factores que contribuye a la aparición de enfermedades no transmisibles, lo que constituye un problema de salud pública mundial. En este contexto, el presente estudio exploró cómo los restaurantes promocionan alimentación saludable.Material y métodos: La investigación fue de tipo cualitativo con un diseño basado en el estudio de casos. Se incluyeron 68 establecimientos pertenecientes al Top 100 de restaurantes con mayores ventas en Colombia, ubicados en la ciudad capital. Se realizó observación y revisión documental de contenidos dispuestos por dichos restaurantes en su página web, redes sociales oficiales y menú web entre abril de 2016 y febrero de 2017. El análisis de la información fue realizado para atributos en Epiinfo 7.2 y para información categorizada con el programa Nvivo 11.0Resultados: De los 68 restaurantes, ocho declararon el desarrollo de acciones de alimentación saludable como parte de su concepto de negocio; no obstante, otros 25 establecimientos también emprendieron acciones en el tema. En mayor medida, se encontró que los restaurantes promocionan alimentación saludable por medio de la oferta de verduras, o por medio de mensajes, en redes sociales, promocionando sus platos saludables.Conclusiones: Sería beneficioso una aproximación más integral en referencia a la promoción de alimentación saludable en restaurantes. Esto no solo en términos de la oferta, sino también de aquellos mecanismos que persuaden elecciones saludables. Al explorar fueron escasos lo resultados sobre estrategias de precios, campañas o información nutricional. Los resultados expuestos son un aporte al reconocimiento de las características de los ambientes alimentarios colombianos, dada la escasa información al respecto y la necesidad de trabajo en este tema con el sector de la restauración.

Estimating the pattern of causes of death in Papua New Guinea

BackgroundPapua New Guinea (PNG) is a diverse country with high mortality and evidence of increased prevalence of non-communicable diseases (NCDs), but there is no reliable cause of death (COD) data because civil registration is insufficient and routine health data comprise only a small proportion of deaths. This study aims to estimate cause-specific mortality fractions (CSMFs) for five broad groups of causes (endemic infections, emerging infections, endemic NCDs, emerging NCDs and injuries), by sex for each of PNG’s provinces.MethodsCSMFs are calculated as the average of estimates obtained from: (1) Empirical cause method: Utilising available Verbal Autopsy (VA) data and Discharge Health Information System (DHIS) data, and applying statistical models of community versus facility CODs; and (2) Expected cause patterns method: Utilising existing estimates of mortality levels in each province and statistical models of the relationship between all-cause and cause-specific mortality using Global Burden of Disease (GBD) data.ResultsAn estimated 41% of male and 49% of female deaths in PNG are due to infectious, maternal (female only), neonatal and nutritional causes. Furthermore, 45% of male and 42% of female deaths arise from NCDs. Infectious diseases, maternal, neonatal and nutritional conditions account for more than half the deaths in a number of provinces, including lower socioeconomic status provinces of Gulf and Sandaun, while provinces with higher CSMFs from emerging NCDs (e.g. ischemic heart disease, stroke) tend to be those where socioeconomic status is comparatively high (e.g. National Capital District, Western Highlands Province, Manus Province, New Ireland Province and East New Britain Province). Provinces with the highest estimated proportion of deaths from emerging infectious diseases are readily accessible by road and have the highest rates of sexually transmitted infections (STIs), while provinces with the highest CSMFs from endemic infectious, maternal, neonatal and nutritional causes are geographically isolated, have high malaria and high all-cause mortality.ConclusionsInfectious, maternal, neonatal and nutritional causes continue to be an important COD in PNG, and are likely to be higher than what is estimated by the GBD. Nonetheless, there is evidence of the emergence of NCDs in provinces with higher socioeconomic status. The introduction of routine VA for non-facility deaths should improve COD data quality to support health policy and planning to control both infectious and NCDs.

Improved control of non-communicable diseases (NCDs) requires an additional advanced concept for public health – a perspective from a middle-income country

A major consequence of all elements of the ‘epidemiological transition’ is the rapid emergence of non-communicable diseases (NCDs) in low- and middle-income countries. In contrast to the outcomes of the ‘Alma Ata Conference for Primary Health Care’, it has not yet been possible to introduce an equally powerful health policy for the prevention and control of NCDs. Major strategies so far are to advise individuals not to smoke and drink alcohol in excess. Additionally, ‘healthy’ nutrition and increased physical activity are also advocated. Policy for preventing and working against NCDs is now part of the Sustainable Development Goals, specifically target 3.4. So far, attempts to soften the influence of NCDs on the health of the people in low- and middle-income countries have been unsuccessful. It is argued here that additional concepts on how public health could operate against NCDs are needed. Major risk factors for NCDs interfere with and alter complex steps within the human metabolism. This paper explores how human metabolism works by assessing advances in molecular biology and research in genetics, epigenetics and gerontology. Recent developments in these scientific disciplines shed light on the complexity of how human health is maintained and diseases are invoked. Public health bodies should be aware, interested and possibly contribute to the aforementioned areas of interest, as far as NCDs are concerned, and translate major developments in a way, that could be useful in improving population health.

Improved control of non-communicable diseases (NCDs) requires an additional advanced concept for public health - a perspective from a middle-income country.

A major consequence of all elements of the 'epidemiological transition' is the rapid emergence of non-communicable diseases (NCDs) in low- and middle-income countries. In contrast to the outcomes of the 'Alma Ata Conference for Primary Health Care', it has not yet been possible to introduce an equally powerful health policy for the prevention and control of NCDs. Major strategies so far are to advise individuals not to smoke and drink alcohol in excess. Additionally, 'healthy' nutrition and increased physical activity are also advocated. Policy for preventing and working against NCDs is now part of the Sustainable Development Goals, specifically target 3.4. So far, attempts to soften the influence of NCDs on the health of the people in low- and middle-income countries have been unsuccessful. It is argued here that additional concepts on how public health could operate against NCDs are needed. Major risk factors for NCDs interfere with and alter complex steps within the human metabolism. This paper explores how human metabolism works by assessing advances in molecular biology and research in genetics, epigenetics and gerontology. Recent developments in these scientific disciplines shed light on the complexity of how human health is maintained and diseases are invoked. Public health bodies should be aware, interested and possibly contribute to the aforementioned areas of interest, as far as NCDs are concerned, and translate major developments in a way, that could be useful in improving population health.