Non Communicable Disease Surveillance A Pilot Project in the District of Polonnaruwa
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Transcript of Non Communicable Disease Surveillance A Pilot Project in the District of Polonnaruwa
Non Communicable Non Communicable Disease SurveillanceDisease Surveillance
A Pilot Project in the District of A Pilot Project in the District of PolonnaruwaPolonnaruwa
Dr Shaluka Jayamanne MD MRCP
Consultant Physician
GH Polonnaruwa
OBJECTIVE OF THE OBJECTIVE OF THE PRESENTATIONPRESENTATION
To present a newly established To present a newly established surveillance system on priority surveillance system on priority chronic NCD in Polonnaruwachronic NCD in Polonnaruwa
To present a community based To present a community based screening programme for a major screening programme for a major health problem in NCP - CRFhealth problem in NCP - CRF
Epidemiology of non Epidemiology of non communicable diseases in communicable diseases in the district of Polonnaruwathe district of Polonnaruwa
Situation of NCDSituation of NCD
Increasing trend with an aging populationIncreasing trend with an aging population
Increasing trend with change in life styleIncreasing trend with change in life style
TransportTransport
AgricultureAgriculture
DiateDiate
Alcohol and tobaccoAlcohol and tobacco
Control of infectionsControl of infections
Epidemiology of NCDEpidemiology of NCD
We do not have a district data baseWe do not have a district data base No Outpatient care statisticsNo Outpatient care statistics Inpatient statistics also have not Inpatient statistics also have not
been audited- Repetitionbeen audited- Repetition
Inadequate documentation Inadequate documentation There is no notification system for There is no notification system for
NCDNCD
Epidemiology NCDEpidemiology NCD
The top three causes of mortality are The top three causes of mortality are related to NCDrelated to NCD
Although NCD are not the leading Although NCD are not the leading causes for hospital admissions they causes for hospital admissions they take up a larger proportion of bed take up a larger proportion of bed occupancyoccupancy
More than 90% of medical clinic More than 90% of medical clinic attendance are related to NCDattendance are related to NCD
Top ten causes of hospitalization
01000
2000300040005000
60007000
Diseases
No. o
f pat
ient
s
Top ten causes of death
0
10
20
30
40
50
60
70
80
Diseases
No. o
f pat
ient
s
Mortality FiguresMortality Figures 200320031. Slow foetal growth and LBW 1. Slow foetal growth and LBW -75-752. Cerebro-vascular Disease 2. Cerebro-vascular Disease -57-573. Renal Failure 3. Renal Failure -56-56
200420041. Renal Failure 1. Renal Failure -89-892. Cerebro-vascular Disease 2. Cerebro-vascular Disease -55-553 Slow foetal growth and LBW 3 Slow foetal growth and LBW -43-43
200520051. Cerebro-vascular Disease 1. Cerebro-vascular Disease -35-352. Renal Failure 2. Renal Failure -28-28
Renal Failure
0
50
100
150
200
250
300
2001 2002 2003 2004 2005
Year
No. o
f pat
ient
s
M(A)
F(A)
M(D)
F(D)
CVA
020406080
100120140160
2001 2002 2003 2004 2005
Year
No. o
f pat
ient
s
M(A)
F(A)
M(D)
F(D)
DM
0
100
200
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400
500
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Year
No. o
f pat
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s
M(A)
F(A)
M(D)
F(D)
MI
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150200
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Year
No. o
f pat
ient
s
M(A)
F(A)
M(D)
F(D)
IHD
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100
200
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2001 2002 2003 2004 2005
Year
No. o
f pat
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s
M(A)
F(A)
M(D)
F(D)
Renal Failure Admissions and Renal Failure Admissions and DeathsDeaths
YEARYEAR M (A)M (A) M (D)M (D) F(A)F(A) F(D)F(D)
20052005 222222 5151 4848 1010
20042004 238238 6969 5656 2121
20032003 222222 ** 3232 *55*55
20022002 158158 ** 6767 *49*49
20012001 ## ** #253#253 *36*36
Cerebroavascular Disease Cerebroavascular Disease Admissions and DeathsAdmissions and Deaths
YEARYEAR M (A)M (A) M (D)M (D) F(A)F(A) F(D)F(D)
20052005 145145 3939 6969 2828
20042004 118118 3131 6868 2525
20032003 106106 ** 138138 *63*63
20022002 112112 ** 7272 *59*59
20012001 ** ## *145*145 #35#35
NCD EpidemiologyNCD Epidemiology
Overall we see an increasing trend in Overall we see an increasing trend in NCDsNCDs
Proportionately death rates have Proportionately death rates have come down marginallycome down marginally
Mortality data has not been assessed Mortality data has not been assessed comprehensivelycomprehensively
Disease burden has Disease burden has changed towards chronic changed towards chronic conditions in Polonnarwa conditions in Polonnarwa
world wide.world wide.
Majority of Majority of Health systems Health systems haven’thaven’t
Prioritizing Prevention & Control Prioritizing Prevention & Control EffortsEfforts
Leading Causes of DeathLeading Causes of Death Years of Potential Life LostYears of Potential Life Lost Economic Cost to SocietyEconomic Cost to Society
Noncommunicable Disease Noncommunicable Disease ModelModel
Your geneticYour geneticendowmentendowment
Personality
Personality
Beliefs
Beliefs
BehavioralBehavioralchoiceschoices
Noncommunicable Disease Noncommunicable Disease ModelModel
Your geneticYour geneticendowmentendowment
Personality
Personality
Beliefs
Beliefs
BehavioralBehavioralchoiceschoices
EnvironmentEnvironment Health C
are
Health C
are
System
System
Wat
er Q
ualit
y
Wat
er Q
ualit
y
AirAirPollutionPollution
Eco
nom
ics
Eco
nom
ics
Importance of a Surveillance Importance of a Surveillance System for Chronic NCDSystem for Chronic NCD
Surveillance provides health information in a timely Surveillance provides health information in a timely manner to fight epidemics now or plan for the future.manner to fight epidemics now or plan for the future.
A SURVEILLANCE SYSTEM: NOT ENTIRELY A NEW A SURVEILLANCE SYSTEM: NOT ENTIRELY A NEW FIELDFIELD• Notification of Communicable DiseasesNotification of Communicable Diseases• Pilot of a Surveillance System in Colombo District Pilot of a Surveillance System in Colombo District
(XXX)(XXX)
The present information systemThe present information system• Xxxxx (status… strengths and weaknesses vis-à-vis Xxxxx (status… strengths and weaknesses vis-à-vis
chronic NCD)chronic NCD)
Transforming the District Transforming the District Information SystemInformation System
POLONNARUWA - AN IDEAL PARTNERPOLONNARUWA - AN IDEAL PARTNER• The success of earlier pilot testing of The success of earlier pilot testing of
information systemsinformation systems Hospital Information systemHospital Information system Drugs management InformationDrugs management Information Public Health Information SystemPublic Health Information System
• Positive Previous experiences Positive Previous experiences Cooperation of the staff in innovative Cooperation of the staff in innovative
projects – Easy to work withprojects – Easy to work with Good motivated team with positive Good motivated team with positive
attitudesattitudes
The Surveillance SystemThe Surveillance System Phase 1:Phase 1:
• CVDCVD HypertensionHypertension Ischaemic Heart DiseasesIschaemic Heart Diseases Cerebrovascular DiseasesCerebrovascular Diseases Congenital Heart Congenital Heart
DiseasesDiseases• DiabetesDiabetes
Phase 2:Phase 2:• Renal diseasesRenal diseases• CancerCancer• Mental healthMental health• OthersOthers
Phase 1Phase 1• GH PolonnaruwaGH Polonnaruwa• BH MedirigiriyaBH Medirigiriya• DH HingurakgodaDH Hingurakgoda• MOH (all 7) AreasMOH (all 7) Areas
Phase 2Phase 2• All Hospitals in All Hospitals in
Polonnaruwa Polonnaruwa • All MOH areasAll MOH areas
Using the NCD NC, enters informationin the MOH NCD registerGenerates NCD Basic Surveillance FormGenerates NCD Special Surveillance Form
- Facilitate continuityof care (e.g. follow up,treatment)- Health promotion
- Risks analysis- Health promotion
PROPOSED CHRONIC NCD PROPOSED CHRONIC NCD SURVEILLANCE SYSTEMSURVEILLANCE SYSTEM
GeneratesNCD NotificationCard (NCD NC)
Using the NCD NC, enters information
in the Hospital NCD Register
Patient
WardDoctor
MOH
PHI
MO/PH
House-hold
RE
CHRONIC NCD SURVEILLANCE SYSTEM:CHRONIC NCD SURVEILLANCE SYSTEM: FORMS & REGISTERSFORMS & REGISTERS
1.1. NCD Notification CardNCD Notification Card
2.2. Hospital NCD RegisterHospital NCD Register
3.3. MOH NCD RegisterMOH NCD Register
4.4. NCD Basic Investigation FormNCD Basic Investigation Form
5.5. PHI NCD RegisterPHI NCD Register
6.6. NCD Monthly ReturnNCD Monthly Return
Programme TodayProgramme Today
CRF- Extent of the ProblemCRF- Extent of the Problem
Leading cause of death at Leading cause of death at GH GH PolonnaruwaPolonnaruwa in year 2004 in year 2004
Among three leading causes for Among three leading causes for hospital medical admissionshospital medical admissions
10% of clinic attendance is due to CRF10% of clinic attendance is due to CRF
Until recently there was no established Until recently there was no established community screening programme community screening programme
Therefore this is the tip of the ice bergTherefore this is the tip of the ice berg
CRFCRF
Main CharacteristicsMain Characteristics Male to Female ratio 5:2Male to Female ratio 5:2 Average age of Diagnosis 30-50 Average age of Diagnosis 30-50
yearsyears More than 95% are farmersMore than 95% are farmers Poor socio-economic classPoor socio-economic class
CRFCRF
Overall analysis shows that 8-10 deaths Overall analysis shows that 8-10 deaths per month is due to CRF or related causesper month is due to CRF or related causes
Average in hospital mortality with CRF is Average in hospital mortality with CRF is about 120/per yearabout 120/per year
Considering the fact that a substantial Considering the fact that a substantial number of deaths occur outside the number of deaths occur outside the hospital we can assume a figure around hospital we can assume a figure around 180180
CRFCRF
It is difficult to give a general figure It is difficult to give a general figure of prevalence with these results but of prevalence with these results but we can assume a 2%-3% prevalencewe can assume a 2%-3% prevalence
Protienurea seems to be a useful Protienurea seems to be a useful cheap markercheap marker
We need a screening programme We need a screening programme using the available infrastructureusing the available infrastructure
Renal Screening and ManagementRenal Screening and Management
Established Renal Clinics led by a VP Established Renal Clinics led by a VP and trained medical officers in renal and trained medical officers in renal medicine in regional hospitalsmedicine in regional hospitals
MedirigiriyaMedirigiriya
BakamunaBakamuna
WelikandaWelikanda
AralaganwilaAralaganwila
Renal ScreeningRenal Screening
Established a continues screening Established a continues screening programme in MOH divisions led by programme in MOH divisions led by community health staff and health community health staff and health volunteersvolunteers
Detection of protienurea and high BP Detection of protienurea and high BP are the main determinantsare the main determinants
Screened patients are referred to Screened patients are referred to clinics for further evaluationclinics for further evaluation
CRF NotificationCRF Notification
CRF patients are notified to the CRF patients are notified to the regional epidemeologistregional epidemeologist
The notification will be forwarded to The notification will be forwarded to the PHIthe PHI
We have submited a data collection We have submited a data collection form to the PHIform to the PHI
CRF Screening programme – PolonnaruwaMOH Area Populati
onNo of clinicHeld Since
Aug . 2006
No of screened
% No of U . alb Positive
No.of S.crPositive
No ofWaiting for
USS
No . OfCRF
Dimbulagala 53466 6 11500 21 482 151 114 14
Elahera 42734 5 6694 15.6 463 170 152 2
Hingurakgoda 64274 2 1639 2.5 60 10 10
Lankapura 36865 2 1352 3.6 65 12 12
Thamankaduwa 83809 4 2263 2.7 164 46 46
Welikanda 36215 5 2368 6.5 106 46 28 3
Medirigiriya Since 2004 Aug.
67860 11 17771 26 693 455
Total 385223 35 43587 11.3 20334.6%
362362 4711%
Establishing Epidemiological DataEstablishing Epidemiological Data
The collected data will be analysedThe collected data will be analysed We hope to screen about 50% of the We hope to screen about 50% of the
population by the middle of next yearpopulation by the middle of next year
Issues for discussionIssues for discussion
Whose responsibility to establish a Whose responsibility to establish a notification system for Chronic NCDs.notification system for Chronic NCDs.
If so when to start national system? If so when to start national system? Funds and human resources ? Funds and human resources ?
Are we going to incorporate it into Are we going to incorporate it into existing system.existing system.
Can PHI measure BP (Using Can PHI measure BP (Using Electronic Device)Electronic Device)