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🌏 Community Medicine · Part 9 revision hub
Non-Communicable Diseases and Their Programmes
Everything you need to revise this Part in one place — the one‑page note for every concept, a rapid‑revision sheet, exam‑style questions that point you back to the right concept, flashcards, staged cases and viva practice.
11 concepts20 MCQs20 flashcards4 cases15 viva questions
📝 The plate wall
Every concept in this Part as a one‑page handwritten note. Open one to read it in full and zoom.
Concept 82
The Rise of Long-Term Diseases
Concept 83
Heart Attacks and Strokes
Concept 84
High Blood Pressure
Concept 85
Diabetes and Obesity
Concept 86
Cancer in the Community
Concept 87
India's NCD Programme
Concept 88
Protecting Sight
Concept 89
Injuries and Road Safety
Concept 90
Mental Health in the Community
Concept 91
Tobacco, Alcohol and Drugs
Concept 92
Growing Old Well and Caring at the End
⚡ Rapid revision
The whole Part on one screen — read it the night before.
NCD burden and strategy
- NCDs ≈ two‑thirds of deaths in India. ICMR‑INDIAB 2023: diabetes 11.4%, prediabetes 15.3%, hypertension 35.5%, generalised obesity ≈ 28.6%.
- 4 behavioural risks (tobacco, diet, inactivity, alcohol) + air pollution → 4 metabolic risks (BP, glucose, lipids, obesity) → CVD, cancer, diabetes, CRD.
- SDG 3.4: one‑third reduction in premature NCD mortality by 2030. WHO "best buys". Prevention paradox → population + high‑risk strategies.
CVD, hypertension, diabetes
- Indians get CHD ≈ 10 years earlier; INTERHEART: 9 modifiable factors ≈ 90% PAR. Treat by total CVD risk (WHO charts).
- BE FAST; stroke thrombolysis within 4.5 h; STEMI hub‑and‑spoke.
- Hypertension ≥ 140/90 on two occasions; salt < 5 g/day; rule of halves. IHCI (2017)/HEARTS: protocol, drugs, task sharing, patient‑centred care, information systems; outcome = BP control rate. "75 by 25".
- Diabetes: FPG ≥ 126, 2‑h ≥ 200, HbA1c ≥ 6.5%, RPG ≥ 200 with symptoms. GDM (DIPSI): 75 g OGTT 2‑h ≥ 140. Asian BMI: overweight 23, obese 25; waist ≥ 90 (M) / ≥ 80 cm (F). IDPP: lifestyle cut progression ≈ 28%. IDRS ≥ 60 high risk.
Cancer, NP‑NCD, vision, injuries
- ≈ 15 lakh cancers/year; men: oral, lung; women: breast, cervix; tobacco ≈ one‑third. NCRP (ICMR, 1981).
- NP‑NCD (NPCDCS 2010 → NP‑NCD 2023): 30+; ASHA CBAC; AAM screening for HTN, DM (annually), oral (OVE), breast (CBE), cervix (VIA) every 5 years (30–65).
- WHO 90‑70‑90 cervical elimination (< 4/100,000). HPV single dose for 14‑year‑old girls (2026).
- Blindness = presenting VA < 3/60 (India adopted 2017). NBVI 2015–19 (50+): blindness 1.99%, cataract ≈ 66%; ≈ 93% avoidable. NPCB 1976 → NPCBVI. Trachoma eliminated (WHO, October 2024).
- Road crashes 2023: 1,72,890 deaths; 66% aged 18–45; 54,568 without helmets. Haddon matrix; Safe System; Good Samaritan (MV Act 2019); cashless treatment up to ₹1.5 lakh for 7 days (2025).
Mental health, tobacco, ageing
- NMHS 2015–16: current prevalence 10.6%, treatment gap 70–92%. NMHP 1982, DMHP 1996 (Bellary), MHCA 2017 (right to care, advance directives, attempted suicide decriminalised: Section 115), Tele‑MANAS 14416 (2022), National Suicide Prevention Strategy 2022.
- GATS‑2: tobacco 28.6%, smokeless 21.4%. FCTC (India ratified 2004). COTPA 2003: s4 public smoking, s5 ads, s6a minors, s6b 100 yards, s7 warnings (85%). NTCP 2007–08; quitline 1800‑11‑2356; PECA 2019. 5 A's / 5 R's. MPOWER.
- 60+ ≈ 10% → 20% by 2050. NPHCE 2010–11; PM‑JAY for all 70+ (Vay Vandana, 2024); MWPSC Act 2007; Elder line 14567. Palliative care: NPPC 2012; Kerala NNPC; NDPS amendment 2014 (oral morphine); living wills (2018).
🎯 Single‑best‑answer MCQs
Pick an answer to see the explanation — and the concept to revisit if you missed it. Your answers are saved on this device.
Score 0 / 00 of 20 answered
Question 1
According to ICMR‑INDIAB (2023), the prevalence of diabetes among Indian adults is approximately:
Question 2
SDG target 3.4 aims to reduce premature NCD mortality by:
Question 3
The INTERHEART study showed that nine modifiable risk factors account for approximately what share of the population attributable risk of MI?
Question 4
The window for intravenous thrombolysis in eligible ischaemic stroke patients is up to:
Question 5
The key outcome indicator of the India Hypertension Control Initiative is:
Question 6
WHO's recommended upper limit of daily salt intake is:
Question 7
An HbA1c value diagnostic of diabetes is:
Question 8
For Asian Indians, obesity is defined as a BMI of:
Question 9
The commonest cancer among Indian women is:
Question 10
In VIA, a positive test is indicated by:
Question 11
Under NP‑NCD, population‑based screening begins at age:
Question 12
The tool used by ASHAs for NCD risk assessment is:
Question 13
Under the WHO definition adopted by India in 2017, blindness is presenting visual acuity in the better eye of less than:
Question 14
The leading cause of blindness among Indians aged 50+ (NBVI Survey 2015–19) is:
Question 15
The Haddon matrix organises injury prevention by:
Question 16
Under the 2025 scheme, cashless treatment for road accident victims covers up to:
Question 17
The national tele‑mental health helpline in India is:
Question 18
Under the Mental Healthcare Act 2017, a person who attempts suicide is:
Question 19
Under COTPA, sale of tobacco is prohibited within what distance of educational institutions?
Question 20
The National Programme for Health Care of the Elderly was launched in:
🃏 Flashcards
Say the answer out loud before you flip. Shuffle once you know the order.
Card 1 of 20
🩺 Staged clinical cases
Read the presentation, decide what is going on and what you would do — then reveal the reasoning.
Case 1 — The control rate problem
Stage A: A block screened 60,000 adults, registered 9,000 with hypertension, but only 1,400 had a BP < 140/90 at their last visit in the past 3 months.
Linked concepts: 84. High Blood Pressure, 87. India's NCD Programme
Case 2 — The positive VIA
Stage A: A 38‑year‑old woman screened at an AAM has an acetowhite lesion on VIA, occupying under 75% of the transformation zone, with no suspicion of cancer.
Linked concepts: 86. Cancer in the Community, 87. India's NCD Programme
Case 3 — The crash black spot
Stage A: A district records 38 road deaths in a year on a 3‑km stretch near a highway market; most victims are pedestrians and two‑wheeler riders, crashing at night.
Linked concepts: 89. Injuries and Road Safety
Case 4 — The quiet grandmother
Stage A: A 78‑year‑old widow on 9 medicines has had two falls, eats poorly and has stopped talking to neighbours.
Linked concepts: 92. Growing Old Well and Caring at the End, 90. Mental Health in the Community
🎤 Viva practice
Answer aloud as if an examiner asked you — then check the model points.
Viva 1
What are NCDs and their shared risk factors?
Viva 2
What is the rule of halves?
Viva 3
Define hypertension and outline correct BP measurement.
Viva 4
What is IHCI?
Viva 5
Diagnostic criteria for diabetes?
Viva 6
Asian BMI and waist cut‑offs?
Viva 7
Common cancers in India and screening tests?
Viva 8
Describe the NP‑NCD screening pathway.
Viva 9
Define blindness and list causes in India.
Viva 10
What is the Haddon matrix?
Viva 11
Key provisions of the Mental Healthcare Act 2017?
Viva 12
Key provisions of COTPA?
Viva 13
What are MPOWER measures?
Viva 14
What are the geriatric giants?
Viva 15
What is palliative care?
Keep going
Educational only — not a substitute for clinical judgement, supervision, or local guidelines.