NCD IN SCHOOL - MAAH · Saidatul Norbaya Buang And Don Ismail bin Mohamed ... HPV Infection FREE...
Transcript of NCD IN SCHOOL - MAAH · Saidatul Norbaya Buang And Don Ismail bin Mohamed ... HPV Infection FREE...
NCD IN SCHOOL FROM POLICY TO ACTION
Saidatul Norbaya Buang
And
Don Ismail bin Mohamed
School Health Sector
Family Health Development Division
13th NATIONAL SYMPOSIUM ON ADOLESCENT HEALTH 5 th – 7 th April 2017, Grand Riverview Hotel, Kota Bharu, Kelantan
1
Presentation Outline
• Defining Non Communicable Disease
• The Causation Pathway for NCD
• Important of Tackling NCD in School
• NCDs Trend Among School Children
• National Strategic Plan for NCD
• NCD Activities In School
• Challenges In Translating Policy Into Actions
• Conclusion
2
Define Non-Communicable Disease
3
• Non-Communicable Diseases (NCDs), also known as chronic diseases, are not passed from person to person.
4 main types of NCDs
• Cardiovascular diseases (like heart attacks and stroke),
• Cancers, • Chronic respiratory diseases (such as
chronic obstructive pulmonary disease and asthma)
• Diabetes.
Other NCDs • Chronic neurologic disorders (e.g.,
Alzheimer’s, dementias) • Arthritis/Musculoskeletal diseases • Unintentional injuries (e.g., from traffic
crashes) • Genetic diseases
Global Health Observatory Data, WHO http://www.who.int/gho/ncd/mortality_morbidity/en/index.htm 3
Source : Adapted from Preventing Chronic Diseases: A Vital Investment. Geneva, WHO 2005
Underlying
Determinants
• Globalisation • Urbanisation • Population Ageing
Common Risk
Factors • Unhealthy diet • Physical Inactivity • Tobacco & Alcohol
Use • Age (Non-
modifiable) • Hereditary (Non-
modifiable)
Intermediate
Risk Factors • Overweiught /
Obesity • Raised Blood Sugar • Raised Blood
Pressure • Abnormal Blood
Lipids
Main NCD • Heart Disease • Diabetes • Stroke • Cancer • Chronic Resp.
Diseases
4
The Causation Pathway for NCD
Area we should tackle…
• NCD is a global issue – affecting all range of age
• Children are the frequent victims of pollution and behaviours such as
tobacco use, physical inactivity and unhealthy diet leading to NCDs
• The burden of NCD in Malaysia continues to increase
• Most of the drivers of NCDs and their risk factors lie outside the control
of the health sector
• Impact on the health, productivity i.e. student’s achievement
5
Important of Tackling NCD in School
• Youth who are overweight or obese have substantially higher odds of remaining overweight or obese into adulthood
Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public-health crisis, common sense cure. Lancet. 2002;360:473-82
.
• Increasing their risk of disease and disability later in life.
Singh AS, Mulder C, Twisk JW, van Mechelen W, Chinapaw MJ. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev. 2008;9:474-88.
6
Important of Tackling NCD in School
• School is a place where intervention can take place in changing knowledge, attitude and behaviour.
• WHO stresses that strategic directions are needed to move forward… tailored approaches to increase the access, coverage, and quality of child health services. (WHO,2016)
7
Important of Tackling NCD in School
8
9
National Strategic Plan for NCD 2010-2014 Seven Strategies for Malaysia
Prevention and
Promotion Clinical Management
Increasing Patient Compliance
Multi-sectoral Collaboration
Monitoring, Research & Surveillance
Capacity Building Policy & Regulatory
Interventions
Education Expectation • Academic excellence
• Functioning adult upon education completion
Health System Expectation • Reduction in Non-
Communicable Diseases in later life
Creation of future adult generation equipped
with
life , social , vocational skills to enable them
making HEALTHY LIFE CHOICES in later life
10
Challenges Implementing NCD Intervention in School Setting
Partnership in Health in School Setting Long standing MOH and MOE relationship since 1967
• 1967
• 3 component model approach
• Alternative chairmanship
Rancangan Kesihatan Sekolah
• 1996
• Health Promoting School Concept
• Alternative chairmanship
Program Bersepadu
Sekolah Sihat • 2008 till present
• Clean, Healthy and Safe School Concept
• Deputy Minister of Education lead the committee
Program 3 K
Health policy in school approved
and monitored through 3x / year
meeting 11
Act, Regulation And Policy
• Education Act 1996, Chapter 12 (a) and (b) • school children must received periodic
medical and dental health assessment
• Convention Right of Child • Disease Control Act • Food Act • Tobacco regulation • National nutrition plan of action • Adolescent Health Policy • Health related Education circulars • 3K meetings decisions
12
Governing Health In School Setting
Translating Policy
• Promote healthy living
• Monitor growth and development
• Screening school children at risk
• Diagnosis
• Intervention and referral
13
Into Activities In School
Healthy Living In School
Health And Physical Activity
Curricular
Health Program In
Schools
PTA Special Programs
Extra Curricular Activities
• Health and physical activity curriculum
• Extra curricular
• Sport, Uniform body, School clubs
• PTA – parents SARANA
• Health programs in school
• Nutrition program
• Mental health screening
Health Policy In School
• Smoke free school
• School against bully
• Accident free zone in school
• Healthy food sale in school
14
The vision for school health is the promotion of the optimal health and development of school going children and the communities in which they live and learn.
The objectives of school health are to support educators and the entire school community in creating Health Promoting Schools, address barriers to learning and in so doing act as a safety net for children who did not have
Nutrition In School
• Guideline on healthy canteen • List of food that CAN be sold, NOT
ENCOURAGE to be sold, and CANNOT be sold
• Surat Siaran Kementerian Pelajaran Malaysia Bil.23, 2012 dated 27th June 2012
• Display of food calorie in school canteen
• School Milk Program
• Food supplement for students from low income group
• School Meal Program
• PTA program
15
Obesity
• Monitoring of children BMI by School Health Teams
• Teachers should take students’ BMI twice a year and inform the parents during academic parent-teacher meeting
• School physical assessment (SEGAK) – monitor BMI twice a year
• Optimizing activities during PE
16
Mental Health
• Screening of student mental health status by counsellors • Form 2 and Form 4
• Screened for • Depression
• Anxiety
• Stress
• Mild to moderate problems – intervention by counsellors
• Severe – direct referral by teacher to Family Medicine Specialist
17
Tobacco
• Towards generation free of tobacco by 2048
• Introduction of I’m Free Program
• Disease Control Division is working with dental in screening school children for smoking status
18
Cancer Prevention
AIM
HPV Infection
FREE immunisation at school
Form 1
GIRLS ONLY
Begin in
2010
Prevent Cervix
Cancer in 20 years
later
PERLIS KEDAH PULAU PINANG
PERAK WPKL SELANG
OR
NEGERI SEMBIL
AN MELAKA JOHOR
PAHANG
TERENGGANU
KELANTAN
WP LABUAN
SABAH Sawawa
k
Bilangan 14803 124425 81751 136316 78548 271618 63459 48931 199526 84365 74652 113740 4372 146563 140813
Peratus 97% 97% 97% 96% 95% 95% 97% 97% 98% 97% 97% 97% 97% 100% 96%
92%
93%
94%
95%
96%
97%
98%
99%
100%
101%
0
50000
100000
150000
200000
250000
300000
MURID PEREMPUAN YANG MENDAPAT PERLINDUNGAN DARI KANSER SERVIKS MENGIKUT NEGERI 2010 HINGGA 2016
• 1,600,827 Form 1 students
received at least 1 dose of HPV
• 1,356,057 Form 1 students recived
optimal protection from HPV
infection and cervical cancer
1 2
3 ACHIEVEMENT TILL NOW
HOW DOES IT WORKS?
19
Genetic Disease
AIM
Thalassaemia carrier
screening among the
Form 4 students
Informed decision among the adolescent
Prevent carrier-carrier marriage
95% reduction of Thalassaemia birth by 2050 OUTCOME 2016
2
3 1
61 students are Thalassaemia patients
5,109 confirmed Thalassaemia Carrier
12,108 awaiting molecular test
22,832 are anaemia
199,174 screened
208,381 students consented for screening
Counselling –
both students
and parents
Treatment
Sumber data: 1. KSK/ST/101 pindaan 2016 2. HKL, 2016
HOW?
20
Disability Detection
• Learning disability
• Partnership with MoE to detect school children with learning disability.
• Objective : education placement in alternative curricular
• Skeletal deformity
• Year 6 and Form 3
• Visual defect
• Year 1, Year 6 and Form 3
• In between yearly by teachers
• Colour defect
• Form 3 21
Challenges In Translating Policy Into Actions
• Striking balance between health and education requirement • How much is adequate or too much? • Child academic achievement vs child
• Nurturing healthy behaviour through integrated education in schools
• Meeting parents and community expectation of education system without acknowledging importance of health skills in shaping future adults health decision making
• Persuade parents to practice healthy behaviour in line with health activities in school
• Sustaining good practice beyond schooling age
22
Conclusion
• The MOH and MOE close partnership will continue to shape the health of school children in Malaysia
• School base health activities to be extended beyond school setting eg. In community and school to allow children continuously practice healthy choices in live
• Coordinated efforts to build future block of healthy adults begin from childhood and school offer opportunity for children to learn health behaviour correctly.
23