Ministry of Health and Population Ministry of Health and Population Preventive and Primary Health Care SectorPreventive and Primary Health Care Sector

Epidemiology and Disease Surveillance Unit (EDSU) NON-COMMUNICABLE DISEASE

SURVEILLANCE SYSTEM, EGYPT 2006

Presented by: Dr. Eman A. EllabanyMedical Epidemiologist

Supervised by: Dr Abdel-Nasser M.ASupervised by: Dr Abdel-Nasser M.AExecutiveExecutive director ofdirector of Epidemiology and Disease Surveillance UnitEpidemiology and Disease Surveillance Unit

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Introduction

Chronic diseases represent a major problem and public health burden in developing countries. It represents 73% of deaths and 60% of global disease burden.

In Egypt, there is emerging evidence that diabetes mellitus, obesity, hypertension and hyperlipidemia contribute to national morbidity and mortality as it represents about 26% of all deaths related to chronic diseases. So, Egypt is in need of conducting national survey to measure the burden and the actual prevalence of chronic diseases

Introduction

Stepwise is a frequent community based survey dealing with prevalence of chronic diseases (diabetes mellitus, hypertension , cardiovascular diseases…etc) and their behavioral risk factors; obesity, hyperlipidemia, smoking, drinking alcohol, feeding habits, oil consumption, and physical activities. Also physical and biochemical measurements.

Step-wise Surveillance System

Stepwise SurveillanceSTEP 1

• Self Report– Demographics– Physical

activity– Diet– Smoking– Alcohol– NCD’s

STEP 2• Physical

– Height– Weight– BP– Waist

circumference

STEP 3• Biochemical

– Fasting glucose

– Cholesterol– Triglycerides– HDL

The Egyptian population in last census was estimated to be around 70 millions. Population: 10000 randomly selected proportioning to the total population considering the selected age group (≥ 15: ≤ 65 years) and gender Sites: random selection of 10 Governorates of 27 to represent the whole geographical area

Sampling frame and design

Sampling frame and designTechnique:

Multistage and Stratified Cluster Random sampling • PSU included Egyptian Governorates as clusters . They

were stratified into Urban / Frontier / Delta / Upper Egypt . 10 of 27 Governorates were randomly selected to represent total population in a proportionate way.

• SSU were districts in each governorate• TSU were streets and buildings• Houses were the end sampling units.

Sampling frame and designWorking team: Consists of

Epidemiologist to fill the questionnaire and supervise other steps during the interview.

Nurse to take blood sample, physical measurements (wt, ht, waist circumference), and measure blood pressure.

Sanitarian from the related health district guides the team towards the selected streets and building

Sampling frame and designTools: • Questionnaire: we use the international

Stepwise questionnaire after translating it in Arabic using the public traditional Egyptian language to facilitate the mission for the interviewer.

• WHO scales & measures for height and weights were standardized.

• WHO supplied the REFLETRON machines and kits for biochemical measurements (Fasting blood sugar, cholesterol, triglyceride, and HDL).

The three steps of the Step-wise survey were done together

The field work of the survey conducted through the year 2005 starting the field work from January to December 2005

Data entry on Access software taking 6 months ( from January to June 2006)

Preliminary descriptive analysis done using SPSS program.

Sampling frame and design

Results of Egypt Steps surveyStep 1

Sample size

• Out of 10,000 a total of 9780 adults participated in the Egyptian Steps survey.

• The overall response rate was 97.8%

Population Pyramid of Egypt

Age distribution by Gender of 9870 Egyptian

participants

Age (year)

perc

ent

40

35

30

25

20

15

10

5

0

SEX

Male

Female

Prevalence Of Education Achieved By The Survey Participants

Education level

Pe

rce

nt

40

35

30

25

20

15

10

5

0

SEX

Male

Female

Employment Status Of Participants

Occupation

Pe

rce

nt

60

50

40

30

20

10

0

SEX

Male

Female

Prevalence of Tobacco smokers

34.6

27.4

0.7 0.4

18

14.2

0

5

10

15

20

25

30

35

Perc

en

t

Male Female Both

Current daily smokers

Manufactured cigarette

Burden of smoking

17

19.6

9.6

18.216.9

19.6

02468

101214161820

Avera

ge n

um

ber

Male Female Both

Average years smoking

Mean No. cigarette/day

Prevalence of Alcohol consumption

3.8

0.3

2.1

0

0.5

1

1.5

2

2.5

3

3.5

4

Perc

en

t

Male Female Both

Percentage of current drinkers (who drank alcohol in the Percentage of current drinkers (who drank alcohol in the past 12 monthspast 12 months))

For those who drank alcohol in the last 12 months

17.1

0

6.1

02468

1012141618

Perc

en

t

Male (≥5 drinks) Female (≥4drinks)

Both (≥4 drinks)

Drinks / day

Percentage who ate 5 or more combined servings of

fruit & vegetables per day

21.3 20.9 21.1

0

5

10

15

20

25

Per

cen

t

Male Female Both

5 serving & more / day

Physical activity

45.1

57.4

50.6

0

10

20

30

40

50

60

Per

cen

t

Male Female Both

< 600 MET

Percentage with low levels of activity (defined as <600 MET-minutes/week)

Results of Egypt Steps survey

Step 2

Physical Measurements (Overweight and obesity)

60

21.8

72.2

39

66

30.3

0

10

20

30

40

50

60

70

80

Perc

en

t

Male Female Both

Overweight /BMI ≥25

Obese / BMI ≥ 30

Prevalence of Hypertension(Percentage with raised BP)

26.3

6.2

27.1

7.6

26.7

6.9

0

5

10

15

20

25

30

Per

cen

t

Male Female Both

SBP ≥ 140 and/or DBP ≥ 90 mmHg

SBP ≥ 170 and/or DBP ≥ 100 mmHg

Results of Egypt Steps survey

Step 3Biochemical Measurements

Prevalence of DiabetesPercentage with raised fasting blood glucose

(≥ 7.0 mmol/L)

6.2

8.2

7.2

0123456789

Per

cen

t

Male Female Both

(≥ 7.0 mmol/L)

Prevalence of raised total Cholesterol

15.7

2

23.1

4.4

19.4

3.3

0

5

10

15

20

25

Per

cen

t

Male Female Both

(≥ 5.2 mmol/L) (≥ 6.5 mmol/L)

Conclusion and RecommendationStepwise Surveillance System is important to

• Collect data and analyze it on an ongoing basis

• Use data for shaping public health policy

• Predict future case load of NCDs

• Monitor impact of public health programs

• A repeat survey is planned for 2008 if funds permit

Conclusion & Recommendation • Standardized sheets for each chronic

patients are needed to get more data about the Egyptian character of patients with chronic diseases

• Application of Health Program for Chronic diseases monitoring is important

• Nationwide standardized database using software.

Thank You