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CINDI HEALTH MONITOR SURVEY -
AN INTEGRATED PART OF CINDI
CONCEPTUL MODEL IN MACEDONIA,
2002
Prim. d-r PhD.
spec. of sports medicine - nutritionist
Lazar Licenovski 13 1000 Skopje phone ++389-02-225-402
mfh.cindi@makedonija.com
INSITUTE OF SPORTS MEDICINE, NUTRITION UNIT, SKOPJE, MACEDONIA
1
Community and primary care-based
demonstration project for health promotion and
noncommunicable diseases (NCD) prevention has
been prepared as an integrated part of conceptual
model for CINDI National Programme.
Republic of Macedonia is in the process of
joining CINDI and implementing the CINDI concept
through the process of health care reform.
In focus of the reform in primary health care is
the implementation of health promotion and NCD
prevention measures in preventive practice of
“family” doctors.
2
The purpose of the study:
1. To analize professional reasons that justify realization
of the CINDI Programme based on information of health
status in the Republic of Macedonia.
2. Assessment of national capacity in primary health
care to realize CINDI project on promoting healthy
nutrition and physical activity in different age groups.
3. The role of National Health Autority in CINDI team
to confirm the Macedonian CINDI-Plan of action in
health promotion heart disease and other chronic disease
prevention in related to physical activity and nutrition
over the next 5 year.
3
Methods:
1.-Secondary data obtained from mortality/morbidity
statistics in the Republic of Macedonia (1990-2001).
-The results for family aggregation of common risk
factors for chronic diseases obtained from medical research
(BMI Systolic/diastolic BP T.Chol. TG HDL LDL Glyc.
smoking decreased VO2max dietary habit and stress) in
randomized simples (Demonstation Projects 1990 and 1998).
2. National capacity in primary health care obtained from
WHO questionnaire connected with “Assessment of national
capacity for noncomunicable disease prevention & control” in
2001 year.
3. Protocol and quidelines about CINDI principles and
strategies for health promotion and disease prevention (WHO
CINDI publications).
4
Results and Conclusions:
1. NCD are the main cause of morbidity and mortality
during the last 10 years in the Republic of Macedonia.
( figures-1 and figure-2).
In the last three decades the cardiovascular disease,
esspecialy coronary heart disease, malignant neoplasm's,
and diabetes mellitus remains the most common cause of
death for the Macedonian population.
In 1972 mortality from them accounting for 37% from
total mortality, and year by year this percentage has
increasing significantly up to 55.6% in 2001 with
continuous trend to this days.
5
Figure 1. Mortality rate from noncommunicable diseases
in The Republic of Macedonia for the period 1991-
2001 up to 100.000 population
500
450
400 464.9 464.9 458.7 468.6
350
385.9
300 359.5
250
200
150
100 140.5 142.6 150.3
129.5
50 108.3 111.4 KVB
0
Cancer
1991 1993 1995 1997 1999 2001
6
Figure 2. Morbidity rate from circulatory diseases in the Republic
of Macedonia up to 100.000 population
Hypertensia
25000 Ischemic hard disease
Cerebro vascular
20000 Circulatory diseases
15000
10000
5000
0
1972 1978 1984 1990 1991 1992 1993 1994 1995 1997 1998
7
The results of common risk factors for
NCD include:
1. BMI distribution varies significantly
according to the stage of transition of a country.
Figure-3 illustrates the tendency for rapidly
increase in the proportion of the population with
high BMI than the proportion of the population with
low BMI in the early stage of transition.
The distribution of BMI tends to change again
in the later phases of transition with an increase in
the prevalence of high BMI among
the poor.
8
Figure 3. BMI Distribution in adult population in Skopje
in the last 10 years (1990-2000 year)
9
Figure 4. Prevalence of systolic and diastolic blood pressure
in adult population in Skopje
systolic BP diastolic BP
10
Figure 5. Prevalence of risk factors for NCD in adult
population from central region in Skopje
80
75
%
60
40 35.9 35.2
28.8 28.2
23.8 23.4
20 14.2 18.2 15.8 18.2
12.5
3.7
2.5
0
0
.5
5
)
PV
.5
)
25
1.
25
4.
ss
s
>6
>6
L<
er
-O
L>
I>
I>
re
ly
ol
ok
M
M
HD
O2
LD
st
G
Ch
(B
(B
sm
<V
.3
T.
.5
>2
>6
TG
ol
1990
Ch
1998
T.
11
2. There are great potencial within primary
health care to realize CINDI project for health
promotion and the primary prevention of major
chronic diseases through changes of lifestyle
of the population such as increased physical
activity and balanced diet (average 1488
population per one MD).
The territory of Republic of Macedonia is
divided into five regions with distrinct centres
for the implementation of all NCD related
preventive activities ( figure 6).
12
Figure 6. Organizational structure – CINDI
HEALTH
MONITOR SURVEY CENTRES in the Republic of Macedonia
16
7 167
1877
1877
14
9 149
15
0 150
38
222 4
389
13
3. The role of the Macedonian Health Authority
in CINDI - team is to accept an alternative
classification system for prevention strategies aimed
at chronic multifactorial conditions.
This is based on three levels of preventivntion
directed at everyone in the population (public health
promotion) an above/average risk groups (selective
prevention) and at high-risk individuals (targeted
prevention).
In this new scheme promotion and prevention
are used to describe those action that occur before
the full development of the condition.
14
This project form a link between precede
medical research and the application of new index
as mathematical model for predicting the effects
of non-pharmacological interventions in the
population at above/ average and high risk for
NCD such as truncal obese individuals with
atherogenic risk factors.
Logistic model in form of equation is:
ln “RR” =108.2588–1.7689 DKN-B in +1.7087 -
BMI in+0.3993- Hb 2.9423-VO2max OPV
–
10.5402 WHO in + 0.0770-50% kcal/h
15
Exponent B can be interpreted in terms of relative risk
(“RR”) in cohort studies. The proposed non-pharmacological
intervention is hypocaloric hiperprotein diets of
1200kcal/d and 1400kcal/d (second phase) since the
relative risk is less than 1 (ln“RR”<1).
Increased physical activity by the recommendations of
ACSM (1993) and CDC (2001) statistically significant
promotes development of VO2max.
Change in level of VO2max at 17.16% from baseline
promotes significant greater reduction in level of WHR OS
sm %fat (%M) body weight (TTkg) LBM kg BMR kcal/d
and LDL/HDL in PAD(physical activity and diet) than
those in D (diet) group obese subjects
(figure 7).
16
Figure 7. Change in level of VO2max and “major” risk factors for NCD in FAD
(physical activity and diet) and D (diet) group of truncal obese subjects
25 %
VO2max
17,1 14,8
HDL 15
10,4
5
TT %M LBM WHR OS LDL/HDL %FAI BMR
-1.8 VO2-OPV
-3,3 -3.3 -3.1 -5
-5.3 -4,5 -5.6 -5,2
-6.3
-7,9 -9,5 -7.7 -9.3 -10,2
-10,3 -15
-25
FAD
-28,6 D
-35
17
SINDI PROGRAMA VO MAKEDONIJA-KONCEPTUALEN MODEL
Ministerstvo za zdravstvo
Koordinativen SINDI Centar
Administrativen del
INTERVENTNI PROCESI
primeneti demonstaciono komunalno
primeneti
od podra~je nivo
od SINDI
zdravst. randomizirani programata populaciono
slu`bi grupi
nezavisni promenlivi
grupi (pol vozrast) -znaewe varijabli varijabli
lokacija(u~ilkolekt) -na~. na
odnes.
-semejstvo
inic. indikatori: -aktiviranost
-kultur. nivo
1.morfo-fiziolo{. na zaednica
-socij.podr{ 1.li~ni zdravst.
rizik-faktori : -masovno
BMI; WHR fin. indikatori: karakteristiki
1. rizik-faktori
vklu~ 2.socio-demogr.
HTAmmHg; fc-mir/max organiz. grupi
Tot. holest; TG 2. morbiditet na karakteristiki
i individui
HDL2-holest “major” HNB 3.socij.okolina.
-skrining na:
VO2 max METTs. 3. mortalitet rizik-faktiri
2.rizik- faktori
edukac./promo SINDI-Konceptualen model
na odnesuvuvawe c Makedonija 2002 godina
:
MONITORING II EVALUACIJA
EVALUACIJA Prim.dr Simovska Vera PhD
ishrana; pu{ewe
hipokinezija. 18
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