# Non-Communicable Diseases and NP-NCD for NEET PG PSM: Screening at 30+, CBAC Score, Diagnostic Cut-offs, Levels of Care

Source: https://tracknation.in/story/non-communicable-diseases-and-np-ncd-for-neet-pg-psm-screening-at-30-cbac-score-diagnostic-cut-offs-levels-of-care (TrackNation — free UPSC notes with PYQs)

> NEET PG Community Medicine: NCD burden in India, the five risk factors, NPCDCS (2010) renamed NP-NCD, population-based screening of everyone aged 30+ for hypertension, diabetes and oral, breast and cervical cancer, how to score the CBAC checklist, hypertension and diabetes cut-offs, which cancer test is done where, and the NCD clinic–CCU–day-care chain — from the NP-NCD 2023-2030 operational guidelines, with verified MCQs and cards.

## Start Here

🎯 **Exam priority: High-yield (Tier 1).** *NCD questions ask the screening age, which five diseases are screened,
the diagnostic cut-offs, where each cancer test is done and how the CBAC risk score works. Everything here is from the MoHFW
**NP-NCD Operational Guidelines (2023–2030)**.*

CBME mapping: **CM 8** (epidemiology and control of non-communicable diseases).

## The Burden and the Risk Factors

- The WHO NCD country profile (2018) estimates NCDs cause **63% of all deaths in India**: cardiovascular disease 27%,
chronic respiratory disease 11%, cancer 9%, diabetes 3%.

- Five shared risk factors: **tobacco** (smoked and smokeless), **alcohol**, **unhealthy diet**,
**insufficient physical activity** and **air pollution** (indoor and outdoor).

- Among Indian women, **breast cancer is the commonest**, followed by cervical cancer; almost three-quarters of cancer
spending is out of pocket.

## From NPCDCS to NP-NCD

- **2010**: NPCDCS (cancer, diabetes, cardiovascular disease and stroke) launched in 100 districts of 21 states.

- **2016**: **population-based screening (PBS)** begins as part of comprehensive primary health care.

- The programme was then widened to **COPD and asthma, CKD, stroke, NAFLD and STEMI** and renamed the
**National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD)**; its operational guidelines cover
2023–2030.

- The **India Hypertension Control Initiative (IHCI)** is a partnership of MoHFW, ICMR, State Governments, WHO-India and
Resolve to Save Lives.

- Data are recorded on the **National NCD portal**, which also generates ABHA IDs.

## Population-Based Screening and the CBAC

Everyone **aged 30 years and above** is screened for **five common NCDs**: hypertension, diabetes, and cancers of the
**oral cavity, breast and cervix**. The ASHA enumerates every family, and each person is first risk-assessed with the
**Community Based Assessment Checklist (CBAC)**:

| **CBAC question**

 | **Answer → score**

 |
| 1. Age

 | 30–39: 0 · 40–49: 1 · 50–59: 2 · ≥ 60: 3

 |
| 2. Smoking or smokeless tobacco

 | Never: 0 · used in the past / sometimes now: 1 · daily: 2

 |
| 3. Alcohol daily

 | No: 0 · Yes: 1

 |
| 4. Waist (women / men)

 | ≤ 80 / ≤ 90 cm: 0 · 81–90 / 91–100 cm: 1 · > 90 / > 100 cm: 2

 |
| 5. Physical activity

 | ≥ 150 min a week: 0 · < 150 min: 1

 |
| 6. Family history of high BP, diabetes or heart disease (parent or sibling)

 | No: 0 · Yes: 2

 |

- The maximum score is 11. Everyone is screened *whatever* their score; a high score only means they are prioritised for the
weekly screening day. *(The form says "a score above 4" marks higher risk; the guideline text says "4 or more".)*

- Part B of the CBAC asks about symptoms — e.g. cough over 2 weeks, blood in sputum, a mouth ulcer or white/red patch not healed in
two weeks — so it also picks up TB, COPD and cancer suspects.

- **Opportunistic screening**: anyone 30+ attending a PHC OPD is screened by the medical officer.

*Worked example:* a 52-year-old man who chews gutka daily, does not drink, has a waist of 96 cm, walks 200 minutes a week and whose
mother has diabetes scores 2 + 2 + 0 + 1 + 0 + 2 = **7**.

## Diagnostic Cut-offs

**Hypertension**: systolic **≥ 140 mmHg** and/or diastolic **≥ 90 mmHg** on **two different
occasions**. Cutting salt is one of the key interventions.

| **Test**

 | **Diabetes**

 | **Pre-diabetes**

 |
| Fasting plasma glucose

 | ≥ 126 mg/dl

 | 110–125 mg/dl (impaired fasting glucose)

 |
| Post-prandial (2-h) plasma glucose

 | ≥ 200 mg/dl

 | 140–199 mg/dl (impaired glucose tolerance)

 |
| HbA1c

 | ≥ 6.5%

 | 5.7–6.4%

 |
| Random plasma glucose

 | ≥ 200 mg/dl with symptoms

 | —

 |

## Cancer Screening — Which Test, Where

| **Cancer**

 | **Screening at HWC (SHC/PHC)**

 | **Confirmation at CHC / district hospital**

 |
| Cervix

 | VIA (visual inspection with acetic acid) — by a trained staff nurse or MO at the PHC-HWC

 | Pap smear, colposcopy, biopsy

 |
| Breast

 | Breast examination (self-breast examination listed at the SHC)

 | Mammography, FNAC, biopsy

 |
| Oral cavity

 | Mouth examination with torch, tongue depressor and mirror

 | Biopsy and histopathology

 |

## Levels of Care

- **Community**: ASHA enumerates families; CBAC risk assessment of every adult.

- **SHC-HWC**: screening for hypertension, diabetes and common cancers by the CHO with ANMs/MPWs; referral.

- **PHC-HWC**: the medical officer confirms and manages referred cases; VIA; opportunistic screening of OPD attenders.

- **CHC NCD clinic**: run by a medicine specialist and/or MO, with an **NCD counsellor**.

- **District hospital**: NCD clinic plus a **Cardiac Care Unit / Cardiac Stroke Care Unit** (emergency cardiac and
stroke care) and a **Day Care Centre** (cancer chemotherapy).

- **Tertiary**: State Cancer Institutes and Tertiary Care Cancer Centres (Strengthening of Tertiary Cancer Care Facilities scheme).

**Targets**: SDG 3.4 — cut premature NCD mortality by **one-third by 2030**; the 2023 Chief Secretaries' conference set
a goal of **75 million people with hypertension and diabetes on standard care**.

## Traps the Examiner Sets

- Screening age is **30**, not 40.

- Five screened NCDs: HTN, DM, oral, breast, cervical cancer — not lung or prostate.

- Cervical screening at primary level = **VIA**, not Pap smear (Pap is at CHC/DH).

- Hypertension needs two separate readings ≥ 140/90.

- Fasting glucose 110–125 is IFG; post-prandial 140–199 is IGT; HbA1c ≥ 6.5% is diabetes.

- CBAC family history scores **2**, alcohol only 1; age ≥ 60 scores 3.

- Day Care Centre = chemotherapy; CCU = cardiac emergencies.

## Rapid-Revision Cards

- 30 years and above.

- Hypertension, diabetes, oral, breast and cervical cancer.

- ≥ 140 and/or ≥ 90 mmHg on two different occasions.

- FPG ≥ 126; PP ≥ 200; HbA1c ≥ 6.5%; RPG ≥ 200 + symptoms (mg/dl).

- IFG 110–125; IGT 140–199; HbA1c 5.7–6.4%.

- VIA by trained staff nurse / MO; Pap, colposcopy at CHC/DH.

- Breast exam at HWC; mammography, FNAC, biopsy at CHC/DH.

- 30–39: 0 · 40–49: 1 · 50–59: 2 · ≥ 60: 3.

- Age ≥ 60 (3); tobacco daily (2); waist > 90/100 (2); family history (2).

- Everyone 30+ screened; high score only sets priority. Max score 11.

- 2010, 100 districts in 21 states; PBS from 2016.

- COPD/asthma, CKD, stroke, NAFLD, STEMI.

- NCD clinic, CCU/CSCU (cardiac/stroke), Day Care Centre (chemo).

- 63%; CVD 27%, CRD 11%, cancer 9%, diabetes 3%.

- Tobacco, alcohol, unhealthy diet, physical inactivity, air pollution.

- SDG 3.4: premature mortality −1/3 by 2030; 75 million HTN+DM on standard care.

## Sources

## Sources

*Facts in this article were checked against these documents.*

- National Programme for Prevention and Control of Non-Communicable Diseases (2023-2030): Operational Guidelines — MoHFW, 2023 (link)

## Test Yourself: Practice Questions

Seventeen questions in NEET PG style.

## Practice Questions (NEET PG pattern)

*Original questions written in the style of the exam: +4 for a correct answer, −1 for a wrong one. Every answer
was checked against the sources listed above. NEET PG papers are not published by NBEMS, so these are not past-paper questions.*

**Q1.** Population-based screening under NP-NCD covers people aged

- (a) 30 years and above

- (b) 45–70 years

- (c) 18 years and above

- (d) 40 years and above

**Answer: (a)** — All individuals aged 30 and above are screened for five common NCDs.

**Q2.** Which of the following is NOT one of the five NCDs in population-based screening?

- (a) Lung cancer

- (b) Oral cancer

- (c) Diabetes

- (d) Cervical cancer

**Answer: (a)** — The five are hypertension, diabetes and cancers of the oral cavity, cervix and breast.

**Q3.** Cervical cancer screening at the PHC-Health and Wellness Centre is done by

- (a) visual inspection with acetic acid (VIA)

- (b) colposcopy

- (c) Pap smear

- (d) HPV DNA test

**Answer: (a)** — VIA by a trained staff nurse or MO at the PHC-HWC; Pap smear, colposcopy and biopsy are at CHC/district hospital.

**Q4.** Under NP-NCD, hypertension is diagnosed when BP is

- (a) ≥ 140/90 mmHg on a single reading

- (b) ≥ 140 and/or ≥ 90 mmHg on two different occasions

- (c) ≥ 160/100 mmHg once

- (d) ≥ 130/80 mmHg once

**Answer: (b)** — Systolic ≥ 140 and/or diastolic ≥ 90 on two different occasions.

**Q5.** A fasting plasma glucose of 118 mg/dl indicates

- (a) impaired glucose tolerance

- (b) impaired fasting glucose

- (c) diabetes

- (d) normal glucose

**Answer: (b)** — FPG 110–125 mg/dl is impaired fasting glucose; ≥ 126 is diabetes.

**Q6.** The HbA1c value diagnostic of diabetes in the NP-NCD guidelines is

- (a) ≥ 6.5%

- (b) ≥ 5.7%

- (c) ≥ 6.0%

- (d) ≥ 7.0%

**Answer: (a)** — HbA1c ≥ 6.5% = diabetes; 5.7–6.4% = pre-diabetes.

**Q7.** In the Community Based Assessment Checklist, a positive family history of high BP, diabetes or heart disease scores

- (a) 1

- (b) 2

- (c) 3

- (d) 0

**Answer: (b)** — Family history (parent or sibling) scores 2; daily alcohol scores only 1.

**Q8.** A 63-year-old woman with a waist of 85 cm, who never used tobacco, does not drink and exercises 180 minutes a week, with no family history, has a CBAC score of

- (a) 3

- (b) 2

- (c) 4

- (d) 5

**Answer: (c)** — Age ≥ 60 = 3, waist 81–90 cm (woman) = 1, others 0 → 4.

**Q9.** Which statement about the CBAC score is correct?

- (a) Everyone aged 30+ is screened whatever the score; high scorers are prioritised

- (b) A score of 0 excludes the person from screening

- (c) Only those scoring above 4 are screened

- (d) The score diagnoses hypertension

**Answer: (a)** — Every individual is screened irrespective of score; the score sets priority.

**Q10.** NPCDCS was launched in 2010 in

- (a) 50 districts of 10 states

- (b) all districts of India

- (c) 640 districts

- (d) 100 districts of 21 states

**Answer: (d)** — NPCDCS began in 100 districts of 21 states in 2010; population-based screening followed in 2016.

**Q11.** Which conditions were added when NPCDCS became NP-NCD?

- (a) Mental illness only

- (b) Tuberculosis and leprosy

- (c) Thalassaemia and sickle cell disease

- (d) COPD/asthma, CKD, NAFLD and STEMI (with stroke)

**Answer: (d)** — The programme expanded to COPD and asthma, CKD, stroke, NAFLD and STEMI.

**Q12.** Day Care Centres under the NCD programme at district hospitals provide

- (a) emergency cardiac care

- (b) dialysis

- (c) palliative home visits

- (d) cancer chemotherapy

**Answer: (d)** — CCUs give emergency cardiac care; Day Care Centres give cancer chemotherapy.

**Q13.** Mammography for breast cancer under NP-NCD is available at

- (a) ASHA home visit

- (b) CHC / district hospital

- (c) PHC only

- (d) sub health centre

**Answer: (b)** — Breast examination happens at HWCs; mammography, FNAC and biopsy are at CHC/district hospital.

**Q14.** According to the WHO NCD India profile 2018 cited by NP-NCD, NCDs cause about what share of all deaths in India?

- (a) 45%

- (b) 80%

- (c) 63%

- (d) 27%

**Answer: (c)** — 63% of all deaths; cardiovascular disease alone 27%.

**Q15.** Which is listed among the five major NCD risk factors in the NP-NCD guidelines, alongside tobacco, alcohol, diet and inactivity?

- (a) Low birth weight

- (b) Hepatitis B infection

- (c) Air pollution

- (d) Iodine deficiency

**Answer: (c)** — The five: tobacco, alcohol, unhealthy diet, insufficient physical activity and air pollution.

**Q16.** SDG target 3.4 aims to reduce premature NCD mortality by 2030 by

- (a) one-third

- (b) 10%

- (c) 25%

- (d) one-half

**Answer: (a)** — SDG 3.4: reduce premature NCD mortality by one-third by 2030.

**Q17.** The India Hypertension Control Initiative is a partnership that includes MoHFW, ICMR, State Governments, WHO-India and

- (a) UNICEF

- (b) the World Bank

- (c) Resolve to Save Lives

- (d) the Gates Foundation

**Answer: (c)** — IHCI partners: MoHFW, ICMR, State Governments, WHO-India and Resolve to Save Lives.

### Active Recall

From memory: state who is screened under NP-NCD and for which five diseases; score the CBAC questions; give the hypertension and diabetes cut-offs; say which cancer test is done at the HWC and which at the CHC or district hospital; and outline the programme's history, levels of care and targets.