BLOQUE: INTERACCIÓN COMUNIDAD EDUCATIVA/ENTORNO

A chronic disease is one which is not immediately fatal but is present for months or years. Chronic diseases such as cardiovascular diseases, cancer, chronic respiratory diseases and diabetes are the leading causes of mortality globally (WHO 2011:75). This invisible epidemic is a neglected cause of poverty. Contrary to common perception, 80% of chronic disease deaths occur in low and middle-income countries (WHO 2011:75). Almost 50% of the adult disease burden and 30% of deaths in low- and middle-income countries is attributable to chronic diseases compared to 15% of the deaths in high-income countries (Lopez, Mathers, Ezzati, Jamison & Murray 2006b:1752).

19 1.7.2 Hypertension

Hypertension is elevated systolic and diastolic blood pressure ≥ 140/90 mmHg. It has been referred to as a "silent killer" (van der Sande, Milligan, Nyan, Rowley, Banya, Ceesay, Dolmans, Thien, McAdam & Walraven 2000:493; Van der Sande, Walraven, Milligan, Banya, Ceesay, Nyan & McAdam 2001:426; Sande MA van der 2003:34) as it often has no early detectable symptoms; however, it is a major cause of serious and disabling health conditions, including heart disease, stroke and renal disease (Duda, Kim, Darko, Adanu, Seffah, Anarfi & Hill 2007:118 ; Hoel 1997:119). It has been identified as a major risk factor for CVD and mortality in sub-Saharan Africa (Addo, Amoah & Koram 2006:897). In relation to mortality hypertension, HIV, tuberculosis and malaria significantly contribute to this in the sub-Sahara Africa region (Addo, Smeeth &

Leon 2007:1015; Agyemang 2006:528; Agyemang & Owusu-Dabo 2008:22).

1.7.3 Risk factors of non-communicable diseases

The common risk factors of NCDs are regarded as behavioural and biological. Both are preventable. The behavioural risk factors are tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol. These behaviours lead to four key metabolic or biological changes: raised blood pressure, overweight or obesity, high blood glucose levels and high levels of fat in the blood. The biological risk factors are also referred to as ‘intermediate risk factors’ that increase the risk of NCDs. The common NCDs (CVDs, Diabetes and cancer) share the behavioural risk factors (WHO 2011:76).

1.7.4 STEPS Approach

The WHO devised a tool to strengthen the surveillance system of non-communicable disease and their risk factors (WHO STEPS 2005:22). The goal of the WHO global NCDs surveillance strategy is to provide standard tools to enable countries to build and strengthen their capacity to conduct surveillance. The approach is based on the concept that surveillance systems require standardized data collection to ensure comparability over time and across locations. It is a flexible approach noted to be applicable in various country situations and settings as well as applicable to disease-specific mortality and morbidity (Bonita 2001:1025).

20 1.7.5 Behavioural risk factors

These are major (preventable) factors identified by the WHO and are tobacco use, harmful alcohol consumption, unhealthy diet (low fruit and vegetable consumption) and physical inactivity (WHO 2005:23).

1.7.6 Biological risk factors

These are factors identified by the WHO and include overweight and obesity, and elevated blood pressure, blood glucose and blood lipids (WHO 2005:25).

1.7.7 Cardiovascular Diseases

These are diseases of the heart and blood vessels and include coronary heart disease, cerebrovascular disease, raised blood pressure, peripheral artery disease, rheumatic heart disease, congenital heart disease and heart failure (WHO 2011:73).

1.7.8 Chronic non-communicable diseases

These are diseases of long duration and generally with slow progression. The term is usually applied when the course of the disease lasts for more than three months and when the aetiology is not an infectious agent (WHO 2011:73). In this particular research, shared risk factors for the NCDs namely CVDs, Diabetes and Cancer are emphasised on.

1.7.9 Kish Method

A technique of random selection of an adult from a household after listing and ranking all eligible individuals by age and sex (WHO 2005:90).

1.7.10 Risk factors

These are behaviours which increase the likelihood of developing NCDs (WHO 2005:17).

1.7.11 Cardiovascular diseases

These are a group of disorders of the heart and blood vessels and they include:

coronary heart disease – disease of the blood vessels supplying the heart muscle;

cerebrovascular disease – disease of the blood vessels supplying the brain (WHO 2015:1).

21 1.7.12 Diabetes

This is a condition in which the pancreas no longer produces enough insulin or cells stop responding to the insulin that is produced, so that glucose in the blood cannot be absorbed into the cells of the body (WHO 2006:21).

1.7.13 Cancer

It is a generic term for a large group of diseases that can affect any part of the body.

Other terms used are malignant tumours and neoplasms. One defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and spread to other organs, the latter process is referred to as metastasizing. Metastases are the major cause of death from cancer (WHO 2015:1).

1.7.14 Epidemiology

It is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control of health problems.

"Study" includes surveillance, observation, hypothesis testing, analytic research, and experiments. "Distribution" refers to analysis by time, place, and classes of persons affected. "Determinants" are all the physical, biological, social, cultural, and behavioural factors that influence health. "Health-related states and events" include diseases, causes of death, behaviours such as use of tobacco, reactions to preventive regimens, and provision and use of health services. "Specified populations" are those with identifiable characteristics such as precisely defined numbers. "Application to control..."

makes explicit the aims of epidemiology—to promote, protect, and restore health (John 2001:62).