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
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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.
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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.
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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).
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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.
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Figure 1. Mortality rate from noncommunicable diseases in The Republic of Macedonia for the period 19912001 up to 100.000 population
500 450 400 350 300 250 200 150 100 50 0
464.9 359.5 385.9
464.9
458.7
468.6
108.3 1991
111.4 1993
129.5
140.5
142.6
150.3
KVB Cancer
1997 1999 2001
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1995
Figure 2. Morbidity rate from circulatory diseases in the Republic of Macedonia up to 100.000 population
H y p e rt e n s ia
25000
Is c h e mic h a rd d is e a s e Ce re b ro v a s c u la r
20000
Circ u la t o ry d is e a s e s
15000
10000
5000
0 1972 1978 1984 1990 1991 1992 1993 1994 1995 1997 1998
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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.
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Figure 3. BMI Distribution in adult population in Skopje in the last 10 years (1990-2000 year)
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Figure 4. Prevalence of systolic and diastolic blood pressure in adult population in Skopje
systolic BP
diastolic BP
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Figure 5. Prevalence of risk factors for NCD in adult population from central region in Skopje
80
%
75
60
40
28.8 23.8 23.4 15.8 3.7 18.2
35.9 28.2
35.2
20
12.5
14.2
18.2
2.5
0
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LD
M
M
h
G
.3 (B
C
5( B
H
T.
>6 .
TG
ol
>2