0910 Non Communicable Diseases

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0910 Non Communicable Diseases Powered By Docstoc
					Present NCDI situation in
       Mongolia

                                         Kh.Altaisaikhan
        /Professor of Medicine, Vice president of HSUM/
 Mongolian step survey on non-
communicable disease risk factors
             2006
    Mongolian step survey on non-
 communicable disease risk factors 2006
 The Mongolian NCD – STEPs survey is a nationwide cross–
  sectional survey, carried out throughout Mongolia in 2005.
 The goal of the survey was to determine the prevalence of
  major NCD risk factors and to establish the baseline
  information for the surveillance of NCDs prevention and
  control.
 The survey was conducted through three subsequent steps
  with the concept of the WHO Stepwise approach for NCD
  surveillance and data obtained from 3411 participants aged
  15-64 years.
   Mongolian step survey on non-
communicable disease risk factors 2006

  Step 1
     Questionnaire
      method
  Step 2
     Physiological
      measurements
  Step 3
     Laboratory
      analysis
 Survey results: Behavioral risk factors
                           1. Tobacco use
1. The prevalence of daily smokers
   was 24.2 % of the surveyed
   population aged 15 - 64 years.
2. There was a marked gender
   difference noted in the prevalence
   of daily smokers. The proportion
   of daily smokers in males (43.1%)
   were higher by 10 times as
   compared to that of females
   (4.1%).
3. An average age of initiation to
   smoking was 20 years.
Survey results: Behavioral risk factors
                 2. Alcohol consumption
1. 30.2% of the surveyed population aged 15-64 years consumed
   alcoholic beverages on a regular basis in the past 30 days; and in
   terms of gender, 44% of the surveyed male respondents and 15% of
   the surveyed female respondents consumed alcoholic beverages on a
   regular basis.
2. In the past 30 days, 2.2% of the surveyed population who consumed
   alcohol on a regular basis were drinking alcohol on 4 and more days a
   week thus presenting to be at high risk; and in regard to gender, 2.5%
   of male regular drinkers and 1.2% of female regular drinkers were at
   high risk.
3. There was a gender difference in alcohol consumption. The
   proportion of alcohol consumption on a regular basis and binge
   drinking were 3 times higher in males as compared to females.
Survey results: Behavioral risk factors
       3. Fruit and vegetable intake
Survey results: Behavioral risk factors
           4. Physical inactivity
Survey results: Health indicators
      1. Overweight and obesity
 Survey results: Health indicators
                     2. Diabetes mellitus
1.   Prevalence of diabetes was 9.3% and this proportion was much higher as
     compared to 3.1% of the data from the survey conducted in 1999.
2.   A proportion of impaired fasting glucose was found in 10.3% and there
     was no remarkable difference compared to the prevalence of 9.2% in
     1999.
Survey results: Health indicators
      3. Hypertension and blood pressure
 The prevalence of hypertension 28.1 (+0.1)%.
 With increased age the prevalence of hypertension was higher in
  both sexes.
    Survey results: Conclusion
   Smoking                    27.6%
   Alcochol in moderate use   5%
   Current use of alcochol    0.7 %
   Unhealthy diet             72.5%
   Physical inactivity        23.1%

 Hypertension                 28.1%
 Diabetes                     8.2%
 Obesity                      9.8%
   Survey results: Conclusion
• 9 in every 10 people (90.6% of the surveyed
  population) had at least one risk factor for
  developing NCDs.
• One in every five people (20.7% of the surveyed
  population) had three or more risk factors or were
  at HIGH risk and in particular,
• One in every two males aged 45 years and above
  were at high risk in developing NCDs.
National programme on prevention
and control of non-communicable
             disease
National programme on prevention and
 control of non-communicable disease

1. Goal
  Reduce deaths caused by major NCDs
  through improving control and surveillance
  of NCDs and their risk factors and through
  effective health promotion action
      The program will be implemented in two stages
      splitting into stage one as to be implemented during
      2006-2009 and two as for 2010-2013
National programme on prevention and
 control of non-communicable disease
1. Objectives
   Objective 1. To create sustainable mechanism for
    coordination on prevention and control of major NCDs
    such as cardiovascular diseases, cancer and diabetes
    mellitus
   Objective 2. To reduce risk factors of major NCDs by
    promoting healthy lifestyles and supportive
    environment
   Objective 3. To make reorientation of health services
    (towards community-based, appropriate, accessible
    and effective) for major NCD-s
Non-communicable disease related
       our experience
 Non-communicable disease related
        our experience
 National survey on diabetes prevalence /2002/ Diabet Med.
  2002 June;19 (6):502-8
 Mongolian NCD STEPS risk factors survey /2005/
 Development of national program on NCD prevention and
  control /2005/
 WHO Local fellowship on NCD prevention and control for
  primary health workers
 NCD Regional Center establishment /2005/ (Khovd,
  Uvurkhangai, Dornod)
 Essential emergency surgical care WHO Local fellowship
  WHO Local fellowship training on primary health care
 Distance learning training program for primary health
  providers
The Diabetes Center in Ulaanbaatar,
              2005
      The Diabetes Center in
          Erdenet, 2005
     New diabetes center was established with 3 rooms at out-
patient clinic in Erdenet cities Central Hospital with necessary
equipments
World Diabetes Day since 2001
     Diabetes Educator Training
                     May 2005

31 Mongolian health professionals were certified as
Diabetes Educators
The incidence of diabetes in Mongolia
    Global strategy of non-
communicable disease prevention
         and control
                   Noncommunicable Diseases
              4 Diseases, 4 Modifiable Shared Risk Factors
              Tobacco        Unhealthy      Physical         Harmful
              Use            diets          Inactivity       Use of
                                                             Alcohol
Cardio-
vascular

Diabetes


Cancer


Chronic
Respiratory
Total deaths around the world:
58 million
Total deaths around the world:
58 million

Deaths from noncommunicable
diseases around the world:
35 million
Total deaths around the world:
58 million

Deaths from noncommunicable
diseases around the world:
35 million

Deaths from noncommunicable
diseases in developing countries:
28 million
Total deaths around the world:
58 million

Deaths from noncommunicable
diseases around the world:
35 million

Deaths from noncommunicable
diseases in developing countries:
28 million

Deaths from noncommunicable
diseases in developing countries
which could have been prevented:
an estimated
14 million
           Noncommunicable Diseases
Mortality among men and women aged 15-59 years (2004)
                                              Noncommunicable Diseases
                                              Projected Deaths in 2015 and 2030
                    30
                                                                                           Intentional injuries
                                                                                           Other unintentional
                    25                                                                     Road traffic accidents
Deaths (millions)




                                                                                           Other NCD
                    20

                                                                                           Cancers
                    15


                    10                                                                     CVD


                                                                                           Mat//peri/nutritional
                    5
                                                                                           Other infectious
                                                                                           HIV, TB, malaria
                    0
                         2004   2015   2030      2004   2015   2030   2004   2015   2030
                          High income             Middle income        Low income
WPRO Pattern of Morbidity is Similar to EURO and AMRO
      Distribution of DALYS, by broad cause group and WHO Region, 1999
      %
 75
                Communicable diseases,                       Noncommunicable
                maternal and perinatal                       conditions
                conditions and nutritional
                deficiencies
 50




25


                                                             Injuries


          AFR     EMR     SEAR      WPR      AMR   EUR
                                                     DALY = Disability-Adjusted Life Year
                                                      Source: World Health Report, 1999
     Noncommunicable Diseases
Global Action Plan 2008-2013: Six Objectives

               1. Integrating NCD prevention into the
                   development agenda, and into policies across
                   all government departments
               2. Establishing and strengthening national policies
                   and programmes
               3. Reducing and preventing risk factors
               4. Prioritizing research on prevention and health
                   care
               5. Strengthening partnerships
               6. Monitoring NCD trends and assessing progress
                   made at country level

               Under each of the 6 objectives, there are sets of
               actions for member states, WHO Secretariat and
               international partners
             Noncommunicable Diseases
                Why working in partnership?
Consolidate fragmented        Promote results-oriented collaborative
efforts                                                      efforts




Engage partners outside the              Scale up by pooling limited
health sector                                             resources
                   Noncommunicable Diseases
                         Global NCD Network


Mission:   Help implement the NCD Action Plan by catalyzing an
           multi-sectoral, multi-level response, with a particular
           focus on developing countries

Goals:     • Increase focus on NCD prevention and control through
             collective advocacy
           • Increase resource availability (both financial and
             human capital)
           • Catalyze effective multi-stakeholder action with a focus
             on country-level implementation
                           Noncommunicable Diseases
                           Global NCD Network: Stakeholders
                                                    Stakeholders from the disease and
                                                    risk factor community:




Stakeholders outside the health sector:
• Ministries of Finance, Trade, Education, Social Affairs
• Development donors (e.g. Austrian Development Agency, Ministry of Foreign Affairs)
• International Financial Institutions
• Intergovernmental Organizations
• Private sector
             Noncommunicable Diseases
             Global NCD Network: Structure       Implemented in 2009

                         WHO                     Implemented in 2010


              International Advisory Council

                          Staff
 Funding
Mechanisms


              Global/Regional Forum Meetings




Working                  Working               Working
 Group                    Group                 Group
 Core competencies for caring for
 patients with chronic conditions

1. Patient-centred care
2. Partnering
3. Quality improvement
4. Information and communication
   technology
5. Public health perspective
  1. Patient-centred care

• Interviewing and communicating
  effectively
• Assisting changes in health-related
  behaviors
• Supporting self-management
• Using a proactive approach
  1. Patient-centred care
Interviewing and communicating effectively

                        5 as approach:
                        1. Assess
                        2. Advice
                        3. Agree
                        4. Assist
                        5. Arrange
1. Patient-centred care
 Supporting self-management
2. Partnering
          • Partnering with
            patients
          • Partnering with
            other providers
          • Partnering with
            communities
  3. Quality improvement

• Measuring care delivery and
  outcomes

• Learning and adapting to change

• Translating evidence into practice
  4. Information and
communication technology
         • Designing and using
           patient registries
         • Using computer
           technologies
         • Communicating with
           partners
5. Public health perspective
                 • Providing
                   population-based
                   care
                 • Systems thinking
                 • Working across
                   the care
                   continuum
                 • Working in
                   primary health
                   care-led systems
Partnerships, Collaboration

  • NGOs
  • CCs
  • UN agencies

				
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