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Screening in communities for non-communicable diseases: The role of rapid diagnostics

Noncommunicable diseases ( NCDs) are a group of chronic diseases that are not communicable. NCDs are diseases of long duration with slow progression and are a significant cause of adult mortality and morbidity worldwide. NCDs kill 41 million people every year and comprise 74% of all deaths globally. Each year 17 million people die from an NCD before the age of 70. And 86% of these premature deaths occur in low and middle-income countries. Cardiovascular disease, cancers, chronic respiratory diseases and diabetes are the leading cause of NCD realted mortality and morbidity. In addition to these, mental diseases are also considered to be a major contributors to the economic losses stemming from NCDs.

According to WHO, rapid urbanisation, globalisation of unhealthy lifestyles and an ageing population are major causes of increasing NCDs globally. With rapid urbanisation and sedentary lifestyle, individuals’ physical activity has decreased greatly. Additionally, the popularity of fast food and snacking has led to unhealthy diets becoming more prevalent among the masses. These factors are contributing to rising blood pressure, increased blood glucose levels, elevated blood lipids and obesity. These are called metabolic risk factors and can lead to cardiovascular disease, the leading NCD in terms of premature deaths. In the majority of cases, metabolic risk factors arise from modifiable risk factors, which are characteristics that can be improved and changed by societies or individuals to improve health outcomes. Some examples of modifiable behaviours are the use of tobacco, physical inactivity, unhealthy diet and excess consumption of alcohol. Tobacco accounts for over 8 million deaths every year including death from the effect of exposure to second-hand smoke. excess use of salt ( sodium) intake leads to 1.8 million annual deaths.[1]. These are the deaths which can be reduced by corrective actions.

Social inequalities and NCDs

Social inequalities in NCD risk factors account for more than half of inequalities in cardiovascular diseases and lung cancer. People in low-income countries and those with low socioeconomic status also have limited access to healthcare for timely diagnosis and treatment of NCDs compared to those in high-income countries or with higher socio-economic status. One of the major reasons for this is that the community living at the low socioeconomic level are predominantly exposed to harmful products and unhealthy dietary practices and have limited access to health services. Additionally, marginalised social groups don’t have access to a healthier diet and equal opportunities for early childhood development and education.

NCDs are prolonged and slow-progressing diseases and a large amount of money is required for constant monitoring and management of NCDs. A study published in 2013 [2], noted that if adults in all the regions worldwide had the same mortality from cancers, cardiovascular diseases, chronic respiratory diseases and diabetes as high-income countries, global mortality from these four diseases would be reduced by 27% for men and 29% for women, which would surpass the global NCD goal of a 25% reduction in mortality worldwide. Reducing NCDs in disadvantaged groups is necessary to achieve a substantial decrease in the global burden.

Population-based screening for NCDs

Population-based screening for common non-communicable diseases in different regions is recommended, but it is difficult to implement in hard-to-reach areas in low socio-economical setups. A study done in 2019 [3] in rural India showed that delivering NCD screening services at home by trained community health workers is feasible and well-accepted. Point-of-care and easy-to-use diagnostic devices can help in regular NCD screening in remote areas. Early diagnosis of the disease can help in early intervention and on-time treatment, increasing longevity and quality of the life. This can help us achieve the global goal of reducing NCD-related deaths to less than 25%.

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