APA reference: 2000 words - APA reference style - 25 references
References: above the year 2007
1. Cardiovascular disease (10 references)
A. Primary Prevention in India 350 words
B. Secondary Prevention in Indiav 350
C. Tertiary Prevention in India 350
2. Type 2 Diabetes in global (15 references)
A. Primary Prevention in low/middle income coutnries 350
B. Secondary Prevention " 350
C. Tertiary Prevention " 350
Critically analyse any particular policy prevention and its impact with evidence.
CARDIOVASCULAR AND TYPE 2 DIABETES
Cardiovascular diseases (CVS) act as a leading cause of mortality globally, as well as in India. These diseases are caused by disorder of the heart and blood vessels taking form of several complications like coronary heart disease, cerebrovascular disease, high blood pressure, peripheral artery disease, rheumatic heart disease and heart failure. With the turn of the century, CVD are reported to be rising with the mortality rates being doubled in India. According to Misra et al. (2017), the prevention of cardiovascular disease-related events is critical in India as CVD affects Indians at least a decade earlier and mostly during the midlife productive years of individuals. Therefore, the focus is on carrying out some specific health promotions and disease prevention programs with essential components of CVD management in India.
A. Primary Prevention in India
Primary prevention of CVD is focused on preventing the onset of the disease. This is achieved through certain modification in lifestyle and making healthy choices related to diet and exercise. Dietary habit can be one of the preventive measures for reducing the risk of cardiovascular disease. A majority of government-led programs in India are focused on creating awareness about making healthy food choices and adding more of green leafy vegetables and fruits in diet. A diet low in sugar, salt, less saturated fat intake and increasing monounsaturated fatty acids act as primary prevention methods (Anand et al. 2015). The consideration for primary prevention of CVD is leading such programs where education of the risky group is of utmost importance. However, lack of awareness and education in rural areas still remains key issue acting a s a barriers to CVD primary prevention in India.
However, there is a lack of proper policy targeting prevention of CVD in India resulting in the absence of successful programs. Though the government has recently started taking initiatives of focused programs for early screening and identification of the rural population, there is still lack of such programs spread across the country.
Tobacco intake and smoking has been identified as a major risk factor for CVD in Indian urban as well as rural areas. Smoking is considered to be the reason of doubled rate of mortality due to CVD. Therefore, cessation of smoking and any other form of tobacco is a key primary prevention method related to CVD (Praveen et al. 2018). Smoking cessation is known to have several benefits irrespective of length or intensity of smoking habit. Moreover, it is the single most cost-effective intervention on primary prevention of CVD.
There is lack of stakeholder lead concentrated efforts to reduce the morality and morbidity arising due to high intake of tobacco and smoking in India. Government polices to reduce the usage are also lacking giving rise to high rates of CVD cases making it a major public concern requiring immediate attention.
B. Secondary Prevention in India
People who are suffering from cardiovascular disease are at high risk of developing recurrent cardiovascular events. Therefore, certain secondary prevention methods of CVD are required in India focused on early diagnosis and prevention allowing medical professionals to provide timely assistance and care for improving the quality of life.
Intensive lifestyle advice like weight reduction, dietary sodium reduction and reducing sugar intake helps in maintain an appropriate blood glucose and blood pressure level. However, it is to be noted that dietary restrictions and exercise regime differ as per the risk factor of CVD. For instance, adults with high risk due to blood lipids are recommended to include more of fruits and vegetables, whole grains and poultry and fish while those with high BP are advised to restrict sodium level intake.
CHD is mainly dealing with a blood pressure level that is needed to be less than 140/90mmHg. The blood pressure firstly has to be less than 140/90 mmHg as it helps in treating with the drug. CHD, a beta-blocker is given along with ACE Inhibitors. As stated by Bhatti et al. (2016), the beta-blocker, as well as ACE Inhibitor, cannot be given which are required for dealing with blood pressure helps to reduce risk of recurrent of vascular event. The blood pressure before a heart attack is targeted to <130/ 80-85 mmHg by ACEI, CCB/ ARB/ thiazide.
The treatment from CHD should be continued for a more extended period. When the evidence of CHD is established, the CVD and peripheral vascular disease are required for frequent monitoring of blood cholesterol levels, which is not mandatory. The total cholesterol is less than 150mg/dl. The LDL cholesterol is needed to be less than 70 mg/dl with total cholesterol, which is higher that helps in reaching desired goals.
CABG surgery that needs to be considered which is adjunct to optimal medical treatment by including aspirin, nitrates as well as lipid-lowering therapy, along with Ace inhibitors and beta-blockers for patients at high risk and is considered as triple vessel disease. According to Khatibet al. 2016), percutaneous trans-luminal coronary angioplasty is considered as a relief for persons who are suffering from refractory angina despite optimal medical treatment.
C. Tertiary Prevention in India
In India, a large number of patients present at tertiary stage when first examined and they have a little margin of safety. This results in Coronary artery bypass graft (CABG) surgey and a major tertiary program implemented in India to treat coronary artery disease. The aim of any tertiary program is to reduce the negative effect of disease and restroing function and avoiding disease-related complexities.
Coronary artery bypasses grafting
Coronary Artery Bypass surgery is one of the tertiary prevention programs, which is conducted for 10.6 weeks after the operation. The program lasts for eight weeks by doing exercise training and dietary consoling. According to Duber et al. (2018), the tertiary care hospitals in India provide prevention in the form of rehabilitation, disease management, and balanced diet and lifestyle modifications. Furthermore, in India the tertiary prevention of CVD is focused on self-management for prevention of major events among existing patients (Hindawi, 2019).
Cardiac rehabilitation (CR) is a key element of prevention and management program of CVD. The benefits of such tertiary initiative are seen in terms of morbidity and mortality while being a cost saving option also. In India, CR is practised in urban areas and is provided by high-cost tertiary care centres. On a majority CR remains underutilized in India due to lack of awareness and understanding of the benefits among health-care professionals as well as patients. The potential barriers to CR in India includes lack of policy for CR, lack of proper health care systems, lack of knowledge and training of health-care professionals and psychosocial impact and poor outlook of patients towards CR. Above all time and financial constraints become the major reason of not availing proper management in the form of nutritional counselling, weight management, lipid management, diabetes management, psychosocial management, exercise training etc. (Babu et al. 2016)
However, the tertiary programs have remained expensive and out of the reach of rural population of the country. To ease out the situation, coronary artery bypass grafting is provided through National programs like CVDs and Stroke (NPCDCS), established NCD clinics at CHC and district levels. The aim of such programs is to ensure opportunistic screening of people above the age of 30 years, providing health education through mass media and develop trained league of manpower to strengthen tertiary level health care facilities.
2. Type 2 Diabetes
Type 2 diabetes means a person suffering from onset diabetes which is characterised by lack of insulin, high blood sugar level and insulin resistance. The common symptoms are unexpected weight loss, increase in thirst and frequent urination. The prevalence of Diabetes is higher among young population in Nigeria.
A. Primary Prevention in low/middle income countries
The Nigerian government has approached to design improvement in health from the grass root. The strengthening of primary healthcare to NCD prevention, treatment and screening is important as T2D is long term which can be prevented through sustainable care. The WHO packages of essential Non-Communicable (PEN) Disease Interventions for Primary Health Care are focusing over using resources that helps to identify Diabetes (Ezuruike & Prieto, 2016). The Diabetes Prevention Program includes adults above 25 years with a body index of 24 kg/m2. The glucose level is 5.3 to 6.8 mmol/L is for balancing insulin level in the body. The consumption of soft drink is needed to be reduced as this helps in avoiding obesity which is one of the primary prevention of diabetes. As stated by Ufuoma et al. (2016), the physical activity, making healthy choices and nutrition can be one of the best measures which are needed for preventing obesity diabetes as well as overweight. The World Diabetes Foundation has focused on empowering by making healthy choices as well as importance in behavioural changes. In according to Awodele & Osuolale (2015), family history and anthropometric indices are one of the significant risk factors of Type 2 Diabetes. However, this risk factor can be reduced by facilitating knowledge, abilities and skills to the people of lower/middle income countries like Bangladesh, Pakistan, Nigeria, Nepal (Longdom, 2019). The disease management program for T2D is based on primary care practises that helps in guiding an individual regarding diabetes. For example, the national insurance scheme is applicable in Nigeria as it allows for holistic care to Nigerian DM service users (Jackson et al. 2015). The Diabetes Association in Nigeria is focusing over DM education program to ordinary people. The adoption of education, psychological support as well as integrating the socio-cultural factors that includes traditional healers help in providing primary prevention of T2D.
B. Secondary Prevention
The secondary prevention of diabetes includes randomized controlled trails that focus on lifestyle changes. Further, pharmacological agents can help in preventing or slowing to overt diabetes. As stated by Ekoru et al. (2019), screening the population to diagnose as well as treat the majority of diabetes with a priority toward scaling of secondary prevention of T2D. In one of the middle-income countries in Africa namely Nigeria, there are 170 million people of diverse culture and language. Cardiovascular diseases are mainly wracking havoc over the middle and lower class people in the lower/middle income countries, as they do not get proper guidance on preventing cardiovascular diseases like type 2 diabetes. The International Diabetes Federation has recognised that only 4.5% to 5% people are translating to national prevalence, which is very low in comparison to the developed countries. According to WHO in Nigerians rate in high blood pressure, rise in blood glucose level, rise in cholesterol and overweight is high. As stated by Ekoru et al. (2019), restoration and strengthening the health system helps in providing better health care needs to people which more chronic disease. The cost-effective technology and approaches help in preventing Type 2 diabetes. As stated by Ala et al. (2017), the glucose test and measuring of glucose level help in identifying glucose level. Measurement of fasting glucose or HbA1s helps in preventing T2D. Neuropathy helps in curing T2D. Treatment of hypertension is needed for the prevention of T2D.Lowering blood pressure level as well as increasing insulin sensitivity helps in reducing weight which is another factor for the reduction of blood glucose level. In according to Adias et al. (2018), micro albuminuria is persistence proteinuria in both IDDM, as well as NIDDM, help in maintaining albumin excretion from the body, which alternatively helps in managing T2D. Hyperlipidaemias is secondary prevention of T2D (Dornhorst & Merrin, 2014). The quantitative and qualitative abnormalities have been a concentration of serum lipid as well as lipoprotein, which is used for increasing the various changes that are needed for preventing the proper management in an effective way (Okoronkwo et al. 2016). The treatment helps in increasing low-density lipoprotein and reducing high-density lipoprotein, which is more potential for atherogenic. Lipid-lowering therapy helps in lowering macro-vascular complications in NIDDM.
C. Tertiary Prevention
The tertiary prevention includes a screening of diabetic complication as it also helps in adding detection of diabetic retinopathy as well as nephropathy. It has been estimated that 85% of amputations were having potential prevention with adequate foot care (Dornhorst & Merrin, 2014). As stated by Kale et al. (2018), retinopathy can be one of the tertiary preventive measures to cure T2D diabetes. The diabetes retinopathy remains among 30 to 64 years of people. The inadequately screened as it is referred to leads to effective ophthalmological treatment engaged to cure individual suffering of T2D (Briggs et al. 2016). Tertiary treatment is avoided in lower/middle income countries of Africa mainly as primary and secondary treatment is taken into consideration (Dornhorst & Merrin, 2014). According to NCD care prevention and controlling depends on various challenges, which are engaged to it. According to the survey, 96% of diabetic patients are from tertiary health facility with symptoms of peripheral neuropathy. Globally there is 3.8 million of death from diabetes. In accordance to Ganu et al. (2016), the cause of death in the middle-income country is from diabetes is high than that of any other disease. The social and cultural obstacles, which include illiteracy, poor quality of work have been elevated as it create stigma. Hence it is associated with an illness, which helps in promoting to secrecy. The diabetic population has been caused as providing the sub Saharan Africa are usually suffering from it induces this. Nephropathy helps in treating diabetes by the help of increasing micro albuminuria. It is engaged in reducing, and various benefits for health are associated with it.