Post on 15-Jan-2016
description
Present NCDI situation in Present NCDI situation in MongoliaMongolia
Kh.Altaisaikhan /Professor of Medicine, Vice president of HSUM/
Mongolian step survey on non-Mongolian step survey on non-communicable disease risk factors communicable disease risk factors
2006 2006
Mongolian step survey on non-Mongolian step survey on non-communicable disease risk factors 2006 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-Mongolian step survey on non-communicable disease risk factors 2006 communicable disease risk factors 2006
Step 1Step 1 Questionnaire
methodStep 2Step 2
Physiological measurements
Step 3Step 3 Laboratory
analysis
Survey results: Behavioral risk factorsSurvey results: Behavioral risk factors
1. Tobacco use1. 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 factorsSurvey results: Behavioral risk factors
2. Alcohol consumption2. 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 factorsSurvey results: Behavioral risk factors
3. Fruit and vegetable intake3. Fruit and vegetable intake
Survey results: Behavioral risk factorsSurvey results: Behavioral risk factors
4. Physical inactivity4. Physical inactivity
Survey results: Health indicatorsSurvey results: Health indicators
1. Overweight and obesity1. Overweight and obesity
Survey results: Health indicatorsSurvey results: Health indicators
2. Diabetes mellitus2. Diabetes mellitus1. 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 indicatorsSurvey results: Health indicators
3. Hypertension and blood pressure3. 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: ConclusionSurvey 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: ConclusionSurvey 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 National programme on prevention and control of non-communicable and control of non-communicable
diseasedisease
National programme on prevention and National programme on prevention and control of non-communicable diseasecontrol of non-communicable disease
1. Goal 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 National programme on prevention and control of non-communicable diseasecontrol of non-communicable disease
1.1. Objectives 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 Non-communicable disease related our experienceour experience
Non-communicable disease related Non-communicable disease related our experienceour 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-Global strategy of non-communicable disease prevention communicable disease prevention
and controland control
Noncommunicable Diseases 4 Diseases, 4 Modifiable Shared Risk Factors
TobaccoUse
Unhealthy diets
Physical Inactivity
HarmfulUse of Alcohol
Cardio-vascular
Diabetes
Cancer
ChronicRespiratory
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 estimated14 million
Noncommunicable Diseases Mortality among men and women aged 15-59 years (2004)
0
5
10
15
20
25
30
2004 2015 2030 2004 2015 2030 2004 2015 2030
De
ath
s (
mill
ion
s)
High income Middle income Low income
HIV, TB, malaria
Other infectious
Mat//peri/nutritional
CVD
Cancers
Other NCD
Road traffic accidentsOther unintentionalIntentional injuries
Noncommunicable Diseases Projected Deaths in 2015 and 2030
AFR EMR EURSEAR WPR AMR
Noncommunicableconditions
InjuriesInjuries
25
50
75%
WPRO Pattern of Morbidity is Similar to EURO and AMRODistribution of DALYS, by broad cause group and WHO Region, 1999
DALY = Disability-Adjusted Life YearSource: World Health Report, 1999
Communicable diseases, maternal and perinatal conditions and nutritional deficiencies
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
care5. Strengthening partnerships6. 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 DiseasesGlobal Action Plan 2008-2013: Six Objectives
Promote results-oriented collaborative efforts
Scale up by pooling limited resources
Engage partners outside the health sector
Consolidate fragmented efforts
Noncommunicable DiseasesWhy working in partnership?
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 DiseasesGlobal NCD Network
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
Stakeholders from the disease and risk factor community:
Noncommunicable DiseasesGlobal NCD Network: Stakeholders
Working Group
Working Group
Working Group
Working Group
Funding Mechanisms
Funding Mechanisms
Global/Regional Forum MeetingsGlobal/Regional Forum Meetings
Implemented in 2009Implemented in 2009
Implemented in 2010Implemented in 2010
International Advisory CouncilInternational Advisory Council
WHO
Staff
Noncommunicable DiseasesGlobal NCD Network: Structure
Working Group
Working Group
Core competencies for caring for patients with chronic conditions
1. Patient-centred care2. Partnering3. Quality improvement4. Information and communication
technology5. 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
5 as approach:1. Assess2. Advice3. Agree4. Assist5. Arrange
Interviewing and communicating effectively
1. Patient-centred careSupporting 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, CollaborationPartnerships, Collaboration
• NGOs• CCs• UN agencies