Role in Prevention and Control of Non Communicable Diseases (NCDs)
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Role in Prevention and Control of
Non Communicable Diseases (NCDs) - extracted text
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Reading Meterial
for
ASHA
Role in Prevention and Control of
Non Communicable Diseases (NCDs)
Book No. 8
^OISS^
2009
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Ministry of Health and
Family Welfare
Government of India
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CHIEF EDITOR:
Dr. R.K. Srivastava,
Director General of Health Services
EDITORIAL BOARD:
Dr. D.C. Jain,
DDG, Dte. GHS
Dr. Jagdish Kaur,
GMO, Dte. GHS
Dr. Sudhir Gupta,
GMO, Dte. GHS
Dr. Mithila Dayanithi,
National Consultant
(NCCP), MOH & FW
Dr. Ritu Rana,
National Consultant
(NCD), MOH & FW
PH -HO
FOREWORD
Issues related to health of child and maternal health, HIV/AIDA and other
communicable diseases, Non-communicable diseases are posing a serious public
health threat today. An increasing burden of Cardiovascular diseases (CVDs),
Diabetes Mellitus, Cancer, Stroke and Chronic Lung Diseases, Fluorosis etc. due
to changing life styles calls for an urgent action and focus on developing health
promotion and prevention strategies.
The National Rural Health Mission (NRHM) was launched on 12"1 April 2005
to provide effective, efficient and affordable health care to rural population. One of
the key components of the Mission is the female health volunteer of the village
‘Accredited Social Health Activist’ (ASHA). The framework of NRHM has also
identified some of the major constraints towards preventive and promotive health.
ASHA is a catalyst in delivering the health care service to the rural population.
Empowering ASHA with knowledge and skills in preventing Non-Communicable
Diseases will be vital in promoting healthy life style to keep Non-communicable
Diseases at bay.
The focus of this manual is to promote healthy life style such as increase
intake of fresh fruits and vegetables, reduce salt consumption, increasing physical
activity, avoidance of tobacco and alcohol use. To sustain the interest of ASHA in
health promoting messages the manual is written in simple language so that it can
be easily adapted and translated by respective States/UTs as per their needs. I
am confident that this publication would serve as an important guide and tool
towards health promotion and control of Non-Communicable Diseases.
Dr. R.K. Srivastava
Director General of Health Services
Government of India
CONTENTS
S.No.
1
Topics
Page No.
Role of ASHA in Prevention and Control of
Non Communicable Diseases
1
2
Healthy Diet
2
3
Regular Exercise
3
4
Tobacco
4-5
5
Alcohol
6
6
Blood Pressure
7
7
Diabetes
8
8
Stroke
9
9
Common Cancers
10
10
Breast Self Examination
11
Oral Cancer
13
12
Mental Health
14
13
Deafness
15
14
Iodine Deficiency Disorders
16
15
Fluorosis
17
16
References
18
11-12
Training Module for ASHA
Role in prevention and control of
Non Communicable Diseases (NCDs)
The primary responsibility of ASHA is to act as an interface between the community
and the public health system. Their role is very important in initiating community
based interventions for behaviour change through IEC for prevention and control
of various non communicable diseases, e.g. diabetes, cardio-vascular diseases,
stroke, cancers, mental health, deafness etc.
Role of ASHA in prevention and control of NCDs
1.
Educate women, men and adolescents regarding the determinants of
NCD’s and various associated risk factors like unhealthy diet, physical
inactivity, intake of Tobacco and Alcohol and Stress, essentiality of
Iodine etc.
2.
Promoting a healthy life style during her regular interactions with the
community.
3.
Assist ANM/LHV in:
•
4.
Organizing camps/village health days on NOD themes
•
Screening of people at high risk
•
Advising patients to consult appropriate levels of health care system
for diagnosis and treatment
Arrange follow up visits.
Promote Healthy Life Style
1
Healthy Diet
Wash vegetables & fruits properly before cooking.
2.
Develop the habit of taking meals at regular intervals.
3.
Avoid overeating.
4.
Use boiling, steaming, grilling etc. as methods of cooking.
5.
Increase of locally available seasonal fruits and green leafy vegetables in
the diet.
6.
Avoid fried foods, restrict intake of ghee, oils.
7.
Reduce salt and sugar intake.
8.
Avoid intake of aerated drinks (cola), fast/processed food (Chips, burger,
samosa etc.).
9.
Increase intake of milk, butter milk, Lassi, coconut water etc.
ZZ5
1.
2
Healthy Diet Makes A Better Life
Regular Exercise
•
Make daily exercise a routine.
•
Exercise for a minimum period of 30 min.
daily, which can be split into intervals.
•
Form a habit of using stairs.
•
Include exercise in your routine work,
develop a habit of walking e.g. to school,
market, friend’s house, workplace etc.
Examples of simple and
comfortable exercises
•
Walking
•
Cycling
•
Jogging
•
Swimming
•
Dancing
•
Playing games/Sports
•
Yogasanas
•
Gardening and household
chores-washing, mopping etc.
Where should I find the time
for exercise
•
At home, at work or during leisure.
•
Combine shopping, gardening etc. with
exercise.
•
Take stairs instead of elevator (upto 3 floors).
•
Walk to nearby shop rather than drive.
Exercise Keeps You Fit & Healthy
3
Tobacco
Tobacco kills 8-9 lakh people every year in India.
It is used in various forms in India which include
cigarette, bidi, hukka. gutka, khaini, gudakhu, pan
masala with tobacco, Pan with tobacco, gul, mawa,
chutta etc.
3. Tobacco smoke contains over 4000 harmful and poisonous
chemicals.
4. Use of tobacco products leads to diseases of the heart,
lungs, cancer, blindness, etc.
5. Use of gutka, khaini and other chewing forms of tobacco
leads to cancer of mouth, food pipe and stomach.
6. Use of tobacco by pregnant women leads to low birth
weight of babies and still birth.
7. Tobacco use leads to impotence and low fertility.
8. Persons exposed to Second Hand Smoke (SHS Smoke
from other person’s cigerette/bidis) suffer from cancer
and diseases of lungs. Young children in the family of
smokers are prone to develop respiratory diseases and
diseases of ear.
9. Bidis are equally harmful as cigarettes.
10. Quitting is possible. Consult the doctor or nearest Health
facility.
1.
2.
Tips to Quit Tobacco
•
•
•
•
•
•
4
Decide a DATE to QUIT
Be confident and Strong
REMOVE all Tobacco products around you (home, office etc.)
Drink lot of water
ALL TOBACCO PRODUCTS are equally HARMFUL!
Take HELP from a doctor or a Tobacco Cessation Clinic
Stop Using Tobacco And Enjoy A Cancer Free Life
Under the law
1.
Smoking is banned in all public places.
2.
All public places should have signages in place saying “No Smoking
Area-Smoking here is an offence".
No Smoking AreaSmoking here
is an offence
3.
Sale of tobacoo products to those less than 18 years is banned.
4.
Sale of tobacco products within 100 yards of all schools/educational
institutes is banned.
5.
All kinds of direct and indirect advertisement and promotion of tobacoo
products is prohibited.
6.
Mandatory pictorial warning on all forms of tobacco products.
TOBACCO KILLS
SMOKING KILLS
Tobacco
Tobacco
■ldl
Tobacco
causes
causes
causes
cancer
cancer
IB’;!
SMOKING KILLS
cancer
■
Choose Life Not Tobacco
5
Alcohol
6
1.
Alcohol use is associated with diseases of heart, liver, kidney, brain,
cancers etc.
2.
Alcohol has socio economic effects also, leading to problems in the
family, compromising of essential goods/items.
3.
Alcohol is not accepted in general by family members whose needs are
compromised, e.g. children, wife, parents.
4.
Predisposes to fights, accidents, depression.
Avoid Consumption of Alcohol And Improve Quality of Life
Prevention and Control of High Blood Pressure (B.P.)
1.
Get B.P. checked at regular intervals
2.
If suffering from high B.P. or any symptoms such as headache, chest
discomfort or pain, take advise of doctors for regular treatment.
3.
Don’t stop or change medicines on your own or advice of friends.
4.
Avoid use of tobacco, alcohol, fried foods.
5.
Reduce high intake of salt and oily food.
6.
Exercise regularly.
7.
Increase intake of seasonal fruits and vegetables.
8.
Avoid stress, practice meditation, yoga, spend quality time with children.
9.
Control weight.
Ways to reduce stress
•
•
•
•
Spend time with the person you like
Think positive
Sleep well
Remember the things
that are good in life
Tips for reducing salt
•
•
•
Take the salt shaker off the table
Avoid adding extra salt to food
Avoid high salf content food e.g.
How to reduce weight?
Limit serving size
Regularize eating habits
Take food at regular intervals of time
Eat only when you are feeling hungry
Do not skip meals
Get Your Blood Pressure Checked Regularly
7
Prevention and control of Diabetes (sugar)
1.
Exercise regularly and control weight.
2.
Avoid excess sugar, sweets, ice cream, chocolate, candies, fried
foods e.g. poori, parantha, potatoes, sweet potatoes, fruits with high
sugar e.g. grapes, mangoes, banana etc.
3.
Avoid tobacco use, alcohol, junk food e.g. aerated drinks, pizzas,
burgers, and other kinds of fast foods.
4.
Cook food in minimum oil.
5.
Increase intake of seasonal green leafy vegetables.
6.
Get Blood Sugar checked regularly and if high consult doctor and follow
advise.
7.
Don’t stop or change medication on your own or advice of friends.
8.
Take advice of doctor for regular tests e.g. kidney function, eye
check up etc.
Foods you should
eat more often
Take a balanced diet
All green and leafy vegetables
like Bittergourd, Lettuce leaves,
Brinjals, Ladies finger, Cabbage,
Cauliflower, Carrot, Soya beans,
Drumstick are good
Cook the vegetables with
minimum oil
Remember...
It is not only important
what you eat, but also
how much you eat
Healthy Habits, Healthy Life
Stroke (Lakwa)
•
Stroke is a brain attack.
•
It is an Emergency.
•
It is due to disruption of blood supply
to an area of brain.
•
Blood supply may be stopped due
to a blood clot/break in blood vessel.
Risk factors for stroke are:
Smoking, Alcohol, obesity, High blood pressure, Diabetes, Heart diseases,
High cholesterol
Life style changes may prevent stroke
STOP SMOKING
MONITOR BLOOD
HEALTHY DIET
EXERCISE
CHECK STRESS
PRESSURE
Fitness is Essential for Healthy Living
9
Common Cancers
Males: Oral cavity, lungs, oesophagus and stomach cancers.
Females: Cervix, breast, oral cavity cancers.
Early Warning Signals of Cancer
Early Warning Signals
C hange in bowel or bladder habits
A wound that does not heal
U nusual bleeding or discharge
T hickening or lump in the breast or elsewhere
I ndigestion or difficulty in swallowing
O bvious change in a wart or mole
N agging cough or hoarseness of voice
Cervix Cancer
Common Symptoms of Cervix Cancer
•
•
•
•
•
•
•
Post-menopausal bleeding
Post-coital bleeding
Intermenstural bleeding
Blood stained discharge per vaginum
Excessive seropurulent discharge
Backache
Lower abdominal pain
Breast Cancer
10
Be Aware And Fight Cancer
i
• A change in size of the breasts
• A nipple that is pulled in or changed in
position or shape
• A rash on or around the nipple
• Discharge from one or both nipples
• Puckering or dimpling of skin of the breasts
• Lump or thickening in the breast
• Constant pain in the breast or armpit
\
Common Symptoms of Breast Cancer
Breast Self-Exam (BSE)
Best time to do:
• Once a month.
• 10 days after your menstrual period.
• If not menstruating, pick a certain day-such as the first day of each month.
• If taking hormones then do it 1-2 days after withdrawal bleeding.
Five Steps of Breast Self-Exam (BSE):
Step 1:
• Stand in front of the mirror with your shoulders
straight and your arms on your hips and look
at your breasts (Breast awareness) and look:
- at their usual size, shape, and colour
- that they are evenly shaped without visible
distortion or swelling
Consult doctor if there is :
- Dimpling, puckering, or bulging of the skin
- changed position or an inverted nipple
(pushed inward instead of sticking out)
- redness, rash, or swelling of the breasts.
Step 2:
• Now, raise your arms and look for the same
changes.
• Look for any dimpling of Skin or in-drawing
nipple.
Step 3:
• While you’re at the mirror, gently squeeze each
nipple between your finger and thumb
• Consult doctor if nipple discharge is milky or
yellow fluid or blood.
Regular Breast Self Examination Can Detect Breast Cancer Early
11
Step 4:
• Lie down and use your right hand to feel
your left breast and then your left hand to
feel your right breast.
• Use a firm, smooth touch with the first
few fingers of your hand, keeping the
fingers flat and together.
• Cover the entire breast from top to bottom,
side to side—from your collarbone to the
top of your abdomen, and from your armpit
to your cleavage.
• Be sure to feel all the breast tissue:
• Follow a pattern to be sure that you cover
the whole breast. Begin at the nipple, moving
in larger and larger circles untill you reach
the outer edge of the breast. Also move
your fingers up and down vertically, in rows.
Begin examining each area just beneath your skin with a very soft touch,
and then increase pressure so that you can feel the deeper tissue, down
to your ribcage using fingers only.
OVERLAPPING
CIRCLES
LINES
Step 5:
• Feel your breasts while you are standing or sitting.
• It is easier to feel the breasts when their skin is
wet and slippery (like while taking bath).
• Cover your entire breast, using the same hand
movements described in Step 4.
12
Do Monthly Breast Self Examination
Oral Cancer
Common Symptoms
of
Oral Cancer:
• A white/red patch in the oral cavity
• Ulceration/roughened areas in the oral cavity,
especially those that does not heal for more
than a month
• Blanching of the oral mucosa
• Difficulty in tolerating spicy foods
• Difficulty in opening the mouth
• Difficulty in protruding the tongue
• Change in voice (nasal voice)
• Excessive salivation
• Difficulty in chewing/swallowing/speaking
Self Examination of oral cavity can detect oral lesions at an early stage.
When to do Oral Self-Eamination (OSE)
•
All habitual tobacco users should do it once a month.
How to do it:
•
Rinse the mouth with water and stand before a mirror in adequate light.
•
Look in the mirror for any abnormal white or red patch, ulcer or roughened
area, granular area or swelling in the mouth.
•
If any such area is seen, the suspicious area should be felt with the fingers.
•
Normal oral mucosal is soft and pink.
•
Consult a doctor if any abnormal area is found.
Oral self examination can detect oral lesions at an early stage
13
Mental Health
14
1.
Depression, anxiety, etc. are common mental disorders and should not
be neglected.
2.
If someone is suffering from any mental illness, medical help should be
sought rather than seeking help from ojhas/tantriks and non conventional
healers.
3.
The mental illnesses are treatable. Mentally ill and their families should
not be discriminated.
4.
Regular treatment under the supervision of doctor/health professional is
essential
5.
If some wandering mentally ill person is located, inform local police to
take the patient to a health facility
6.
Drugs are available at Primary Health Centres for treatment of mental
illness. Contact doctor at PHC for help.
7.
Parents of school children suffering from exam stress should seek help
from a doctor and provide all possible support to the child.
Mental Illnesses Are Treatable-do Not Discriminate The Mentally III And Their Families
Deafness
1.
All new borns (within two months of birth) should be examined for
congenital deafness, by simple tests e.g. making noise (with metallic
spoon and bowl or shaking a matchbox/rattle) and watching for baby to
turn head towards the source.
2.
If the parents complaint of some difficulty in hearing in their child, advice
to seek help from PHC doctor.
3.
All cases of discharge from the ear should be referred to PHC doctor.
4.
Avoid exposure to loud noises e.g. crackers, loud speakers etc.
5.
Avoid playing loud music or un-necessary blowing of horn etc.
6.
Don’t slap or hit children on ears.
7.
Don’t put sharp objects into the ears to scratch or clean. Use soft cotton
swabs gently for cleaning the ears.
8.
Elderly persons with decreased hearing should consult doctor for advice
regarding hearing aid. Wearing hearing aid should not amount to stigma,
as wearing spectacles for low vision is not a stigma.
Avoid exposure to loud noises
Don’t put sharp objects into
Use of Sharp Objects Into The Ears May Cause Deafness
15
Iodine Deficiency Disorders (IDD)
Iodine
• Is a natural element essential for
normal growth, development and
functioning of both the brain and
body.
• Its deficiency can cause various
disorders like :
- Swelling of the neck (goiter)
which is most common,
- Mental retardation,
- Poor school Performance,
- Deaf-mute,
- Squint,
- Difficulties in standing or
walking normally,
- Stunting of limbs.
- Pregnant women may suffer
from abortions and still births.
Regularly use of iodized salt can prevent above disorders.
Use only Iodized Salt
• Sale of non-iodized salt is banned throught India.
• Use salt testing kits to test the salt at household level for presence of
iodine in adequate amount.
Precautions while storing the salt
• The salt should be protected from direct sunlight, high temperature and
moisture.
• Store the salt in an airtight container made of plastic, wood, glass or clay
with a well fitting lid.
• Don not store the salt for more than 6 months as it reduces the quantity
of iodine, so buy only that much salt which you can consume quickly.
16
Use Only Iodized Salt & Store it in a Air Tight Container
Fluorosis
• Is caused due to the entry of fluoride into the body
through drinking water and food, and to a certain extent
through industrial emission, drugs and dental products.
• Consumption of water and food with high fluoride level
by a pregnant woman can result in abortions, still births
and deformed babies. Breast feeding by such mothers
can also pass on fluoride to infants.
Symptoms of Fluorosis
• Nausea, loss of appetite, pain in stomach, bloated
feeling, constipation with intermittent diarrhea. Eczema,
dermatitis, muscle weakness, excessive thirst,
frequent urination, fatigue, nervousness, depression,
tingling sensation in fingers and toes,
• Dental and Skeletal changes are mostly irreversible.
• Yellowish brown discoloration of permanent of teeth
usually after 8 year of age.
• Limitation of joint movements, crippling deformities and
muscle wasting.
Do’s in Fluorosis
• Get the source of your drinking water tested for fluoride level. If the levels
are high then look for alternative safe source.
• Rain water harvesting.
• Dilution of Fluoridated water with rain water.
• Iron rich foods: Banana, Guava, Spinach, Brinjal.
• Calcium: Milk, Yoghurt, Cheese, Jaggery, Green leafy vegetables, Cumin
seeds, Arby, Drumsticks and Kamal Kakdi.
• Vitamin C: Amla, Guava, Lemon, Oranges, Tomato.
• Vitamin E: Vegetable oils, Nuts, Whole Gram Cereals, Green vegetables.
• Anti-oxidants: Garlic, Ginger, Onion, Carrot, Papaya, Sweet Potato.
Don’ts in Fluorosis
• Black Tea, Supari, Black Rock salt (Kala Namak) and Tobacco Chewing.
• Avoid use of Fluoride toothpastes, mouth rinses etc.
If you find anyone with symptoms of Fluorosis refer
him/her to the hospital.
Fluorosis is an easily preventable disease
17
References
18
(i)
Annual Report 2007-08.
(ii)
National Cancer Control Programme, www.mohfw.nic.in
(iii)
www.cancer.gov
(iv)
National Programme on Prevention and Control of Diabetes, CVD & Stroke,
www.mohfw.nic.in
(v)
National Mental Health Programme, www.mohfw.nic.in
(vi)
National Mental Health Programme, National Health Programme Series,
NIHFW.
(vii)
National Programme and Control of Deafness, www.mohfw.nic.in
(viii)
National Iodine Deficiency Disorders Control Programme, www.mohfw.nic.in
(ix)
National Programme for prevention & Control of Fluorosis, www.mohfw.nic.in
(x)
National Tobacco Control Programme, www.mohfw.nic.in
(xi)
Report on Tobacco Control in India, 2004.
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Ministry of Health and Family Welfare
Government of India
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