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Current situation in control strategies and Health Systems in SINGAPORE by Law Hai Yang Deputy, Director, National Thalassaemia Registry

Current situation in control strategies and Health Systems in SINGAPORE by Law Hai Yang Deputy, Director, National Thalassaemia Registry

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Singapore - Current Situation in Control Strategies and Health Systems in Asia Singapore - Current Situation in Control Strategies and Health Systems in Asia Presentation Transcript

  • Current situation in control strategies and HealthSystems in AsiaSINGAPORE 8 February2012 < single image > g g 4.3cm x 5.5cm Law Hai Yang Deputy Director Natiional Thalassaemia Reigistry
  • Demography (2010) (2010) Land area 712.4 km2 Temperature 24.9 – 31.9 OC Total Population 5,076,700 076, Resident Population 3,771,700 3,771, Density 7,126/km2 Ethnic Groups Chinese 74.1% Malay 13.4% Indian 9.2% Others 3.3%2
  • Demography (2010) (2010) Annual Birth Rate A l Bi th R t 9.3/1 000 3/1,000 3/1 1,000 Total Live-Births Live- 37,967 Infant Mortality Rate 2.0 /1000 Live-Birth Live- Life Expectancy at Birth 81.8 Years Doctor per 1,000 Population 1.7 Average Income* g $4,800 (US$3,713) ( , ) Total Health Budget* $4.1 (US$3.17) billion Subsidies for medical care* $2.2 (US$1.7) billion ( ) *$1 (USD) = $1.2926 (SGD) 16 Jan 20123
  • Health System – Public/Government (1) Affordable, Good Quality Healthcare Hospitals • 5 general hospital • 1 women’s and children’s hospital • 1 psychiatry hospital 6 Specialty Centres • Cancer, cardiac, eye, skin, neuroscience and dental care Total 185 – 2064 beds 18 polyclinics l li i
  • Health System – Public/Government (2) • Medisave Medishield ElderShield and Medisave, Medishield, Medifund schemes exist to help Singaporeans “co-pay” their medical expenses. • $20 million allocated to Medication Assistance Fund to help needy patients with high cost drugs. g g • No special policy on Hb disorders.
  • Health System – Private 16 Hospitals • 20 – 505 beds ~2000 Private Clinics Medisave, Medishield, ElderShield and Medifund not applicable
  • Diagnostic ServicesPopulation Screening • National Thalassaemia Registry • Cascade screening – first degree relatives •GGenetic C i Counseling liClinical laboratory y • Full blood count, Hb electrophoresis • All major hospitals and private labs j p p • Outpatient and prenatal screeningMolecular Diagnostic Lab (Carrier & Prenatal testing) • KK Women’s and Children’s Hospital • National University Hospital
  • National Thalassaemia Registry (NTR) Established:1992年 Location:KK Women’s and Children’s Hospital Aim : • Register all thalassaemia carriers • Free counseling • Subsidized screening Referral :• Government and private hospitals, Clinics • Consent • Self referral Effective in identifying carriers
  • Screening Full blood count Hb electrophoresis (HbH inclusion bodies) Mutation analysis
  • Prenatal screening FBC of couple MCV < 80 for one or both MCV > 80 for both MCH < 26 for one or both MCH > 26 for both Hb electrophoresis for No further action HbH inclusion body both HbE +ve HbA2  HbH +ve HbH -ve & both MCV < 80 HbE trait -thal trait -thal trait If spouse is If spouse is -thal trait -thal trait Consider -thalassaemia minor - Do DNA and family studies
  • Thalassaemia carrier rate 2000 unrelated individuals:  Thalassaemia 2.91 %  Thalassaemia 0.93 0 93 % HbE 0.64 % Total 4.49 %
  • Number of allele screened No of alleles No of mutation - thalassaemia 4971 26 -th l thalassaemia i 3105 53
  • NUMBER OF NTR REGISTRANTS2010 • Number of Registrants 43,471 • Number Screened 24,989 • Number of Carrier 30,679 NTR Population p Chinese 72.6% 74.1% Malay 17.6% 13.4% Indian 4.8% 4 8% 9.2% 9 2% Others 5.1% 3.3%
  • Type of thalassaemia2010 -thalassaemia carrier 14129 (45.97%) -thalassaemia  thalassaemia carrier 11550 (37 58%) (37.58%) HbE 3652 (11.88%) HbH disease 521 (1.70%) Concurrent -thalassaemia carrier  thalassaemia 352 (1.15%) (1 15%) HbE with -thalassaemia 101 (0.33%) -thalassaemia 89 (0.29%) major
  • Number of -thalassaemia majors born 30 25 20 15 10 5 0Before Year 1971-1975 1976-1980 1981-1985 1986-1990 1991-1995 1996-2000 2001-2005 2006-2010 1970 19 0
  • -thalassaemia majors Chinese 66.3% Malay 23.6% Indian Others 4.5% 5.6% n = 89
  • -thalassaemia minors Chinese Malay 77.5% 77 5% 14.3% Indian 5.2% Others 3.0% n = 11550
  • HbE Carriers Malay M l 75.5% Indian I di 2.2% Others 12.7% Chinese 9.6% n = 36 2 3652
  • HbE -thalassaemia Malay 74.3% Indian 4.0% Others 4.0% Chinese 17.8% n =101
  • -thalassaemia minors Chinese 82.8% Malay 8.2% Indian 4.1% Others h 5.0% n = 14129
  •  and -thalassaemia carriers Malay Chinese 8.5% 79.5% Indian 6.5% Others 5.4% n = 352
  • HbH Disease Chinese 86.2% Malay 7.1% Indian Others 0.8% 6.0% n = 521
  • TreatmentBlood transfusion • Non-remunerated • US$21 27 (RCC) or US$52.22 (Washed Cells) US$21.27 US$52 22 • Average 4 weekly transfusion • Target at Hb Level of 9 g/dL Iron chelation •Deferroxamine (Desferal) D f i (D f l) •Deferiprone (L1) •Deferasirox (Exjade) •Combination therapy (Desferal & L1)• Bone marrow transplant
  • Monitor Cardiac and other complicationsCardiac • T2* Technology available at National Heart CentreOther complications • Singapore General Hospital • National University Hospital
  • Conclusion • The strategy of screening family members of index cases has been effective in identifying new carriers. • The incidence of the major form of the disease has decreased significantly with effective screening and preventive strategies in place. • The reduction in the number of affected homozygotes has allowed expensive optimal treatment to be available to nearly all those afflicted with the major form of the disease.
  • Thank you y < single image > 4.3cm x 5.5cmThis presentation contains information which is confidential and/or legally privileged. No part of this presentation may be disseminated, distributed, copied, reproduced or relied upon without the expressed authorisation of SingHealth.