Module 5
Non-Communicable Diseases
Prevention and
Control
1
UNIT 1. INTRODUCTION TO NCDs
Basics & epidemiology of NCD
• NCD is a disease that cannot be transmitted from person/animal to person.
• The leading causes of ill health and death worldwide, accounting for more than 60% of all deaths
are:
• Cardiovascular diseases,
• diabetes,
• obstructive lung disease and
• cancers .
• Mental illnesses are responsible for high levels of mortality and disability, accounting for:
• 8.8% of the deaths and
• 16.6% of the total burden of disease in low- and middle-income countries.
• Globally, uncorrected refractive errors are the main cause of moderate and severe visual
impairment.
• Cataracts are the leading cause of blindness in middle- and low-income countries. 2
Basics & epidemiology of NCD ….
• Cardiovascular diseases, diabetes, obstructive lung disease, and cancers are on the increase
all over the world, but particularly in low- and middle-income countries.
• Worldwide, they are the leading cause of ill-health and death, accounting for more than 60%
of all deaths.
• According to WHO reports in 2014, 285 million people are estimated to be visually impaired
worldwide.
• 39 million are blind and 246 million have low/poor vision; 82% of people living with
blindness are aged 50 and above. Globally, uncorrected refractive errors are the main cause
of moderate and severe visual impairment.
• Mental illnesses are also responsible for high levels of mortality and disability, accounting
for 8.8% of the deaths and 16.6% of the total burden of disease in low- and middle-income
countries.
• The World Health Organization has estimated that 30% of deaths in Ethiopia were due to
non-communicable diseases in 2012. 3
Basics & epidemiology of NCD …
• About 90% of the world’s visually impaired people live in low-income settings.
• Cataract remains the leading cause of blindness in low- and middle-income countries.
Between 1–2% of the adult Ethiopian population (400,000–800,000 people) is affected
by psychosis.
• A further 10–15% of the adult population (4–6 million people) suffers from depression
at some point in their lifetime—approximately 5% (2 million) at any one time.
• In addition, we estimate that around 5% of the adult population of Ethiopia will suffer
from an anxiety illness at some point during their lifetime.
• Added to this large number is the 3–5% of the adult population who have a serious
problem resulting from excessive use of alcohol or khat.
4
Basics & epidemiology of NCD …
• According to the 2005/6 National Survey on Blindness, the leading causes of blindness in Ethiopia are
cataract (49.9%) and trachoma (11.5%).
• Other causes are corneal opacity (7.8%), refractive error (7.8%), and glaucoma (5.2%).
• 2. Non-communicable diseases (NCDs) are diseases and medical conditions that are non-infectious
and non-transmissible.
• They are of long duration and generally have slow progression.
• Non-communicable diseases do not result from an acute infectious process, but infectious diseases
can be a contributing cause.
• 3. Cardiovascular diseases, diabetes, chronic obstructive lung diseases, cancers, psychosis, depression,
anxiety, substance use (alcohol and khat), cataract, refractive error, and glaucoma.
5
Session 2. NCD risk factors and healthy life style
• Enabling objective:
• 1: Describe the common preventable risk factors for NCDs.
• 2: Demonstrate skills of NCDs risk assessment
• 3: Identify and discuss messages to promote healthy lifestyles.
• 4: Exhibit enhanced skills in risk modification and promoting healthy lifestyle
6
Describe the common preventable risk factors for NCDs.
• NCDs are linked by four preventable lifestyle related risk factors:
• tobacco use,
• unhealthy diet,
• lack of physical activity, and
• alcohol use.
7
Demonstrate skills of NCDs risk assessment
• Screening:
• Screening refers to the implementation of a simple diagnostic test to determine whether an individual has a
given condition or not.
• Risk factors assessment must be administered to all clients during home visits, whether they
have specific complaints related to NCDs or other conditions.
• Risk factors assessment includes:
• Anthropometric measurements,
• Diet and nutrition,
• Level of physical activity,
• Smoking status, and
• Alcohol intake.
8
Identify and discuss messages to promote healthy
lifestyles.
Important messages
9
Important messages
• Message 2: Physical activity
• Regular physical activity promotes physical and psychosocial well-being.
• It improves the body’s function and reduces the severity of other factors that may increase risk
for heart disease, such as obesity, hypertension, and high blood levels of sugar, cholesterol, and
uric acid.
• The minimum recommended amount of physical activity needed to achieve health benefits is 30
minutes per day of moderate intensity activity for 5 days or more days a week.
• When doing vigorous intensity activity, 3 or more days a week reaps health benefits.
• Physical activity prescriptions for every age group and chronic condition ensure that an activity is
safe and fits the need and interest of the individual.
10
Important messages
11
Important messages
• Message 4: Health risks and social consequences of alcohol consumption
• Health risks and social consequences associated with alcohol drinking include its toxic,
intoxicating, and dependence-creating properties.
• Excessive alcohol drinking is also associated with an increased risk of injuries—
including traffic—and has been shown to lead to development of chronic diseases.
12
Strategies/ways to mitigate NCD-related nutrition problems
• There are three main strategies ways to mitigate NCD-related nutrition
problems.
• Aim for ideal body weight.
• Build healthy nutrition-related practices.
• Choose foods wisely.
• Low salt, low fat, and increased fiber in the diet decrease risk of developing
NCDs.
13
Strategies…
• Regular physical activity promotes physical and psychosocial well-being
• improves the body’s function and
• reduces the severity of other factors that may increase risk for heart disease, such as obesity,
hypertension, and high blood levels of sugar, cholesterol, and uric acid.
• The minimum recommended amount of physical activity needed to achieve health
benefits is 30 minutes/ day of moderate intensity activity for 5 days or more days a
week.
• When doing vigorous intensity activity, 3 or more days a week reaps health benefits.
• Physical activity prescriptions for every age group ensure that an activity is safe and
fits the need and interest of the individual. 14
Strategies…
• HEPs have a significant role in promoting a smoke-free environment and smoking cessation.
• Simple interventions include:
• • ASKING about smoking.
• • ADVISING smokers to quit.
• • ASSISTING by providing information and referrals to smoking cessation programs.
• ARRANGING follow-up to prevent relapse.
• Health risks and social consequences associated with alcohol drinking include:
• its toxic, intoxication, and
• dependence-creating properties.
• risk of injuries—including traffic—and has been shown to lead to development of chronic diseases.
15
Exhibit enhanced skills in risk modification and promoting
healthy lifestyle
• Healthy lifestyle promotion
• Role play (40 minutes)
• Be in group six.
• Group 1 & 2 will practice on promoting good nutrition and dietary practices;
• Group 3 & 4 will practice promoting physical activities;
• Group 5 & 6 will practice avoiding alcohol and smoking.
• Take a turn being a client, a health extension worker, and an observer,
• Present to the plenary.
• Take feedback.
16
UNIT 2. MAJOR NCDs (HPN and DM)
• Cardiovascular disease (CVD) or heart disease is any disease or condition
that affects or damages the heart or blood vessels.
• Hypertension or high blood pressure is when:
• The systolic pressure in a blood pressure reading is => 140 mm Hg, and
• The diastolic pressure is equal to or greater than 90 mm Hg.
• Moreover, the adult BP is:
• Normal if readings are less than 120 mmHg systolic pressure and less than 80 mmHg
diastolic pressure.
• Pre- hypertension:
• if readings are 120–139 mmHg systolic pressure and 80–89 mmHg diastolic pressure.
• Hypertension:
• if readings are 140 or higher mmHg systolic pressure and 90 or higher mmHg diastolic
pressure.
17
Hypertension…
• Hypertension is one of the most common cardiovascular conditions in our
country.
• Persistent high blood pressure is one of the risk factors of stroke & heart attack.
• The latter conditions and rheumatic heart disease are the other common CVDs of
public health importance in Ethiopia.
18
Identify the common causes/risk factors for HPN
• Four shared behavioral risk factors are responsible for most cardiovascular
diseases: These are;
• Unhealthy diet (e.g., high salt, fat, and sugar intake);
• Physical inactivity leading to obesity;
• Alcohol use and
• Tobacco use/ smoking.
19
Prevention measures for hypertension
• Prevention measures for hypertension include;
• Encouraging people to stop over-eating, stop/reduce salt, sugar, fatty
food(animal fat), hardened fat, cheese, and whole milk intake;
• Stop smoking cigarettes;
• Reduce alcohol intake;
• Exercise regularly;
• Control weight and body mass index;
20
Identify the common signs & symptoms of hypertension
• Identify the following symptoms by saying ‘Hypertension’ and ;Not
Hypertension’
• DIZZINESS BLURRED
• SKIN RASH VISION
• HEADACHE
• BACKACHE
• HEART BURN
• NOSE BLEEDS
• ABDOMINAL PAIN
• YELLOW EYE
21
Hypertension’ and ;Not Hypertension’….
• EXCESSIVE RINATION
• HIGH FEVER
• CHEST PAIN
• EATCHING
• JOINT PAIN
• RESTLESSNESS
• BLOODY
• DIARRHEA
22
Sign and symptoms of HPN
• ANS: The signs of “HYPERTENSION” are:
• headache,
• dizziness,
• blurred vision,
• Chest pain,
• nose bleeds, and
• restlessness, because these are known as symptoms of hypertension.
23
Screen, identify, and refer hypertension patients
• Steps on how to take a blood pressure manually
• 1. Ask the patients to sit up straight with their arms stretched forward
• 2. Make sure that the patient is relaxed and calm before proceeding.
• 3. Turn the sphygmomanometer’s air release valve clockwise to close.
• 4. Find the patient’s pulse by pressing the middle and index finger against the inside crease of the
patient’s elbow & Put stethoscope
• 5. Pump the rubber bulb until no sound comes through the stethoscope.
• 6. Release the air at a rate of 2–3 millimeters per second.
• 7. The patient’s systolic and diastolic pressure will be taken.
• 8. Take the patient’s blood pressure once or twice again for accuracy. Wait at least 5 minutes
between readings so that blood flow returns to arm.
24
Prevention, control, and treatment modalities of hypertension.
• The adoption of healthy behaviors:
• can reduce blood pressure & cardiovascular risk and
• Can reduce the dose and number of antihypertensive medications required.
• These behaviors are:
• weight loss/healthy weight maintenance,
• limiting alcohol consumption,
• not smoking or using any other tobacco products (e.g., snuff),
• making healthy dietary choices, and
• regular physical exercise.
25
Counsel patients on treatment compliance & adherence
• Hypertension is a life-long condition that requires that you take medication on a
daily basis unless advised otherwise by a health provider.
• The ‘5 As ‘for treatment adherence
• Assess-Review the medication with the patient
• Advise-Reinforce the info on hypertension & give additional info
• Agree-Agree on solutions to adherence problems (if present).
• Assist-Provide adherence support
• Arrange-Schedule another home visit.
26
Questions
• 1. How do you define CVDs and hypertension?
• ANS:
• A CVD or heart disease is any disease or condition that affects or damages the heart or
blood vessels.
• 2. What are the behavioral risk factors responsible for most cardiovascular
diseases?
• ANS:
• Four shared behavioral risk factors are responsible for most cardiovascular diseases:
unhealthy diet (e.g., high salt, fat, and sugar intake); physical inactivity leading to
obesity; alcohol use; and tobacco use.
27
QUESTIONS…
• 3. What are the most common symptoms of hypertension?
• ANS: tiredness, confusion, nausea or upset stomach, vision problems/trouble
seeing, nosebleeds, more than normal sweating, skin that is flushed and red or
pale or white, anxiety or nervousness, palpitations (strong, fast, or obviously
irregular heartbeat), ringing or buzzing in ears, inability to get an erection,
headache, and dizziness.
• 4. What healthy lifestyle choices help reduce blood pressure and
cardiovascular risk?
• ANS: weight loss/healthy weight maintenance, limiting alcohol consumption,
not smoking or using any other tobacco products (e.g., snuff),making healthy
dietary choices, and regular physical exercise
28
Session 2. Diabetes mellitus
Classification of DM
• There are several types of diabetes, but the most common are:
• Types 1 and
• Type 2 are Worldwide,
• About 90% of people with diabetes have type 2 and about 10% have type 1.
• Gestational diabetes accounts for very small numbers of cases.
29
Common risk factors of diabetes
• The common risk factors for DM are:
• Sedentary life
• Gestational DM
• Hypertension
• Obesity Ageing
• Tobacco smoking
• Family Hx. Of DM
• Ethnicity
30
Common signs and symptoms of DM
• The Common signs and symptoms of DM are:
• Feeling thirsty all the time,
• Drinking a lot of water and
• Passing large amounts of urine, and/or weight loss.
• Some patients describe:
• Feeling of emptiness in the stomach,
• Wanting to eat frequently, and
• Tiredness.
• People who have diabetes may report episodes of:
• feeling faint, dizzy, or even losing consciousness.
• This can happen if the blood glucose levels fall too low to support normal
brain function.
31
Screen, detect, and refer diabetes cases
• BMI is a tool used to screen DM and help to refer clients accordingly.
32
DM interpretation
• This classification system was divided in 6 categories:
• Underweight < 18.5
• Normal weight (18.5-24.9)
• Overweight (25.0-29.9)
• Obese-I class (30.0-34.9)
• Obese-II class (35.0-39.9)
• Obese-III class >40.0
33
DM
• Obesity is the number one contributing cause of diabetes today and it
complicates the care of diabetes, which can make treatment with medications
less effective.
• Being overweight and having diabetes will also increase the risk for diabetes
related complications such as kidney failure, blindness and heart disease.
• Being overweight is a risk factor for developing type 2 diabetes.
• However, simply weighing someone may not accurately determine if they are
overweight.
• The key point is their difference in height. One may be taller and assessed as
average weight for their height, where as the other is assessed as obese because
they are much shorter.
• The relationship between weight and height is determined by calculating the
person`s BMI.
34
Prevention, control, and treatment modalities of DM
• The management of diabetes entails:
• 1) Diabetes education;
• 2) Proper nutrition;
• 3) Physical activity;
• 4) Weight control;
• 5) Cessation of smoking;
• 6) Cessation of alcohol intake, and;
• 7) Adherence to diabetes drugs intake.
• People with diabetes and their families need to know that diabetes is serious
chronic disease that has no cure,
• DM can be controlled;
• Diabetes complications are preventable;
• regular medical check-ups are very important.
35
Prevention, control, and treatment
modalities of DM
• The cornerstones of diabetic treatment include: 1) individualized education
and counseling;2)what foods,
• how much, and how often to eat; 3)how to exercise and the precautions (a
light snack before and after
• the exercise); 4) how and when to take medications.
• Stress the value of physical activity and exercises in the prevention, control,
and management of diabetes.
• Good nutrition is a key pillar of prevention, control and management of
diabetes. Diabetics need to eat
• a healthy, balanced diet with food components from all the food groups.
36
Prevention, control, and treatment
modalities of DM
• Medication and management of diabetes mellitus: People living with type
1 disease need insulin for the
• management of their diabetes. People living with type 2 diabetes should be
mainly managed with oral
• drugs. Insulin can be used when oral drugs are ineffective.
• Adherence to diabetes management is very important in maintaining blood
sugar levels and preventing
• diabetic complications.
• Insulin is the mainstay of therapy for patients with type 1 DM and should
be promptly initiated as a lifelong
• treatment.
37
Prevention, control, and treatment modalities of DM…
• Metformin:
• is the first-line oral anti-diabetic agent in patients with type 2 diabetes:
• who are not controlled by lifestyle Mgt. only and
• who do not have contraindications like renal insufficiency, advanced liver disease,
hypoxia or drug intolerance.
• Metformin dose:
• 500 mg, PO daily (after the evening meal);
• Side effects: anorexia, nausea, vomiting, abdominal discomfort and diarrhea;
• Contraindications: Chronic kidney disease (Creatinine >1.5 for males and Creatinine >1.4
for females), advanced hepatic disease, and heavy alcoholism). 38
UNIT 3. CANCERs
• Introduction
• Cancer is the name for diseases that cause the body’s cells become abnormal and divide
without control.
• Cancer cells may invade nearby tissues and may spread through the bloodstream and
lymphatic system to other parts of the body.
• Cancers can develop in any part of the body, but are more common in certain organs than
others.
• The top five organs in which fatal cancers developed worldwide in 2008 were:
• Lungs (1.4 million deaths).
• Stomach (740,000 deaths)
• Liver (700,000 deaths).
• Colon and rectum (610,000 deaths).
• Breast (460,000 deaths).
39
CA….
• Genes are structures that determine:
• what type of cells will develop,
• how they function, and
• how the cells are arranged, nourished, stimulated, and protected in the body.
• Tumors:
• can be either ‘benign’ or ‘malignant’ and
• have a dramatic effect on a person’s chances of survival.
• Benign tumors are:
• rarely life threatening, though some may grow very large over a long time and eventually
interfere with the functioning of a vital organ, such as the liver, heart, or brain.
• Malignant tumor is:
• the medical name for a cancer.
• Some cells in a malignant tumor break away from the original primary mass of cells and
spread around the body through the blood stream or lymphatic vessels.
40
Session 2. Risk factors for cancer
• Cancer is a complex group of diseases with many possible causes.
• Known causes of cancer include but are not limited to the following:
• Genetic factors;
• Lifestyle factors such as tobacco use, diet, and physicalactivity;
• Certain types of infections; and
• Environmental exposures to various chemicals and radiation.
• A carcinogen is a substance or agent that tends to cause cancer.
41
Risk factor for cancer
• The following are risk factors for cancer:
• Old age.
• Cigarette smoking and chewing tobacco or khat.
• Genetic factors.
• Environmental risk factors, such as radiation and certain viruses.
• Exposure to certain industrial chemicals (e.g., insecticides).
• Lack of exercise.
• Fatty diet leading to obesity.
• Excessive alcohol consumption.
42
Cancer..
• The following are important cancer risk-reduction strategies:
• Avoid cigarette smoking or chewing tobacco or khat.
• Avoid excessive alcohol usage
• Eat a healthy diet containing plenty of fruits, vegetables, and other high-
fiber foods
• Maintain a healthy weight
• Avoid exposure to industrial chemicals by wearing personal protective
clothing.
• Avoid exposure to cancer-promoting viruses. 43
Session three: Breast Cancer
Causes of breast cancer
• The cause of most breast cancer is unknown.
• Genetic factors are involved in about 2% of cases, and
• women who are obese and/or eat a high fat diet, or drink a lot of alcohol are more at risk,
• There is no clear cause in most cases.
• Benign lumps in the breast are very common, so you need to reassure women.
• Only about 1 in every 5 women with a breast lump turns out to have cancer.
• Breasts change with the phases of the menstrual cycle, during which levels of female
reproductive hormones (estrogen and progesterone) fluctuate.
• Sometimes these changes result in temporary lumps in the breast.
• Some women develop small painless lumps just before their menstrual period, which
disappear after a few days.
• Sometimes a small tender cyst develops, which also disappears after a few days.
• If a lump felt in the breast remains for two weeks, it is wise to get it checked by a health
professional.
44
Risk factors for breast cancer
• The primary risk factors for breast cancer are being female and older age.
• Other risk factors include:
• genetics,
• lack of childbearing or lack of breastfeeding,
• higher levels of certain hormones,
• certain dietary patterns, and
• obesity.
45
Risk factors for breast cancer…
• The risk factors for breast cancer can be summarized as below:
• Modifiable:
• Lifestyle factors:
• drinking alcohol,
• lack of exercise,
• Poor diet (especially high fat diets),
• obesity,
• smoking,
• estrogen exposure and radiation 46
Risk factors for breast cancer…
• Non-modifiable risk factors:
• Age- risk increases above 40,
• race,
• gender and
• individual or family history of breast cancer
47
Risk factors for breast cancer…
• Smoking tobacco increase the risk of breast cancer, with the greater the amount
smoked and the earlier in life that smoking began, the higher the risk.
• A lack of physical activity has been linked to ~10% of cases.
• Sitting regularly for prolonged periods is associated with higher mortality from breast
cancer.
• A number of dietary factors have been linked to the risk of breast cancer.
• Dietary factors that increase risk include a high fat diet, high alcohol intake, and
obesity-related high cholesterol levels.
• Other risk factors include bearing children after age 40 or not giving birth at all.
48
Signs and symptoms of breast cancer
• The normal breast
• The breasts of a woman are made of fat, supportive tissue, and tissues with glands called lobes.
• They are connected to the nipple by a network of ducts.
• Most women’s breasts are slightly different from each other.
• They change throughout a woman’s life and often feel different at different times in the month.
• Under the skin, an area of breast tissue extends into the armpit (axilla).
• The armpits also contain a collection of lymph nodes, which are part of the lymphatic system.
• There are also lymph nodes just beside the breastbone and behind the collarbones.
• These drain the breast tissues and are affected in breast diseases and inflammatory conditions.
• A network of tiny lymphatic tubes connects the lymph nodes. 49
Symptoms of breast cancer
• Breast cancer is a malignant tumor that starts in the cells of the breast.
• A malignant tumor is capable of (spreading) to distant areas of the body.
• Metastasis
• Lump or thickening in the breast tissue;
• Deformity,
• Ulcers, and
• Discharge from the nipple;
• Skin changes;
• Redness and nipple crusting.
50
Screening for breast cancer and self-examination to
detect breast cancer as early as possible
• Self examination:
• Advise women in your community to examine their breasts once every week, using the
method of breast self- examination illustrated below.
• Refer women who find a breast lump to the HC to seek the required further diagnosis and
treatment as early as possible.
51
The normal breast
52
Steps in breast self-examination
• A) View the breasts with arms down at your sides.
• B) Look at your breasts for the same signs as in (a), but this time with your arms raised.
• C) Repeat the visual inspection with your hands on your hips.
• D) Raise your right hand above your head; with all four fingertips of your left hand, gently press
• E) Hold your right nipple between the thumb and first finger of your left hand; gently roll the nipple,
feeling for any lumps or tenderness. Repeat with the left breast.
• F) Lie down and stretch your left arm upwards and behind your head. Use small circular pressures
with the fingertips
• The steps of breast self-examination: steps (a)–(c) are done facing a mirror.
• Step (f) is done in lying position.
53
54
Breas cancer…
• If a woman :
• feels an unusual lump or any palpable mass in the breast, or
• sees a change in the appearance of the breast,
• she should go to the nearest health center for further assessment and
specialist treatment.
• These types of changes in the appearance or ‘feel’ of the breast should alert a
woman to seek medical help
55
Abnormal breasts
56
Prevention of breast cancer
• Because no one knows exactly what causes it, there are no SURE ways to prevent breast
cancer. However, the following illustrations may help to reduce your risk.
57
Session 4: Palliative care for patients who have
advanced cancer
• Palliative care:
• is given to a person who has advanced cancer (or any other chronic life-
threatening condition).
• The aim of palliative care is :
• to improve the quality of life of the sick individual and his/her family in the period before
the death, and
• to help the family cope with the bereavement after the death.
58
Palliative care….
• Palliative care involves:
• prevention and relief of suffering, pain, and other physical problems, and
attention to psychosocial and spiritual issues.
• It focuses on helping a person enjoy what remains of his/her and managing
symptoms such as pain and nausea.
• It also helps relatives to cope with overwhelming feelings related to losing a
loved one.
• Palliative care strives to keep a patient in his/her own home.
59
UNIT 4: MENTAL HEALTH
• Unit specific Objectives:
• By end of the session, the participants will be able to:
• Explain about the main features and manifestations of mental illnesses and to
identify the common risk factors for developing the illnesses.
• Explain about their roles in providing mental health services and be aware of their
own attitude whether or not it affects their routine activities while caring for
mentally ill patients.
60
Session 1: Common mental illnesses and the risk
factors
61
62
Risk factors of common mental illness using the social ecology model.
63
Session 2: The role of HEPs in the prevention,
control, referral, and follow up of mental illness
64
UNIT 5. EYE HEALTH
• Characteristics of the normal eye include:
• Eyelid opens and closes properly.
• No lumps on lid.
• Lashes do not turn in.
• Colored part of the eye should be smooth and shiny, and have no white
marks or broken blood vessels.
• The white of the eye should be white, except for a few visible blood
vessels. It should not be red.
65
EYE HEALTH…
• In Ethiopia, according to the 2005/6 National Survey on Blindness, Low Vision, and
Trachoma, the prevalence of blindness was 1.6% and low vision 3.7%, which
represents one of the highest prevalence rates in the world.
• This survey showed that the leading causes of blindness in Ethiopia are
cataracts(49.9%) and trachoma (11.5%).
• Other causes included corneal opacity (7.8%);refractive error (7.8%); and glaucoma
(5.2%).
• The major causes of visual impairment are cataract (42.3%);refractive errors (33.4%);
and trachoma 7.7%.
• However, 80% of all visual impairment can be prevented or cured. 66
EYE HEALTH…
• Blind people need to be referred to an eye care provider to check if anything
can be done to restore their sight.
• People who are incurably blind need rehabilitation services to help them to live
well.
• They need to be part of the community.
67
EYE HEALTH…
• Negative effects of blindness/low vision include:
• Economic:
• Unable to meet basics need, absenteeism from work, decreased income.
• Social:
• Decreased school performance, increased accident (e.g., car).
• Psychological:
• Depression, loneliness, anxiety, suicidal thoughts, and dependence.
68
Session 2: Cataracts
• The major risk factors for cataracts are uncontrolled diabetes mellitus, eye injury, and
direct exposure to sunlight, smoke, and fumes.
• As an UHE-p, you should consider cataracts when a person comes to you with
complaints of changes such as blurred vision, difficulty seeing in bright light, inability
to see distant objects or scenes, poor color vision, and difficulty reading.
• As cataracts progress and the lens become more opaque, the person might say that
s/he feels like s/he is looking through cloudy glass.
• The area of the pupil will appear white or cloudy when the cataract is found at a late
stage. 69
Session 3. Glaucoma
• Unfortunately, most cases of glaucoma do not occur with readily noticeable symptoms to
warn of the irreversible optic nerve damage being done.
• However, the presence of the following indicates that a person needs a thorough examination
by an eye doctor:
• unusual trouble adjusting to dark rooms,
• difficulty focusing on near or distant objects,
• squinting or blinking due to unusual sensitivity to light or glare,
• change in color of iris,
• red-rimmed, encrusted, or swollen lids,
• recurrent pain in or around eyes,
• double vision,
• dark spot at the center of viewing,
• lines and edges appear distorted or wavy,
• excess tearing or “watery eyes”,
• dry eyes with itching or burning,
• seeing spots and ghost-like images.
70
Glaucoma…
• The following may indicate serious problems that require emergency medical
attention:
• sudden loss of vision in one eye,
• sudden hazy or blurred vision,
• flashes of light or black spots and Halos or rainbows around light.
• The symptoms mentioned above may not necessarily mean that you have
glaucoma.
• However, if you experience one or more of these symptoms, contact your eye
doctor for a complete exam.
71
Who is at risk for glaucoma?
• High eye pressure alone does not mean that a person has glaucoma, but it is an important risk
factor.
• An ophthalmologist will use it to determine your risk for developing the disease.
• Important risk factors include;
• age, elevated eye pressure,
• thin cornea,
• family history of glaucoma,
• nearsightedness,
• past injuries to the eyes,
• steroid use, and
• a history of severe anemia or shock.
• Individuals who have diabetes and hypertension may have an increased risk of developing
open-angle glaucoma.
72
Session 4. Refractive error
• Major symptoms of refractive error are:
• blurred vision,
• difficulty reading or seeing,
• up close,
• crossing of the eyes in children (exotropia),
• headache,
• double vision and cloudy vision.
73
Refractive error…
• Screening:
• refers to the implementation of a simple test that helps determine whether an individual has a
given condition.
• The primary goal of screening is to detect a disease in its early stages.
• Screening is disease-specific.
• It is the presumptive identification of unrecognized disease or defect by the application of tests or
other procedures that can be applied rapidly.
• It is not a diagnostic measure but a preliminary step to diagnosis.
• Diagnostic tests and evaluation by a health professional/physician are needed for definitive
diagnosis.
• Screening can be on an individual or in groups (mass screenings).
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Refractive error
• Symptoms used for HEPs to screen people for refractive error:
• Reduction in vision
• Sudden or gradual onset
• Blurring or diplopic (double vision)
• Pain
• Headache
• Tearing
• Discharge
• Photophobia (fear of light)
• Trauma
• Previous eye disease
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Thank you!!
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