Chronic Disease In Malaysia


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  • (smoking from 16 to 25 cigarettes - increases your risk for type 2 diabetes to three times that of a non-smoker.
  • Narrowing of the arteries, a greater than normal volume of blood, or a quicker or stronger heartbeat, cause increased pressure against the artery walls
  • (men are at greater risk until the age of 55, then the risk becomes similar for men and women. After the age of 75, women are more likely to suffer from high blood pressure). For both women and men, blood pressure tends to increase with age
  • echniques for breast examination. (A) To spread breast tissue evenly over the chest wall, experts recommend the patient roll on her contralateral hip with her shoulder rotated (so that she is in a supine position, with her ipsilateral hand on her forehead). A pillow or towel can be used underneath the patient's shoulder or lower back to aid in comfort and ensure most effective positioning. (B) The full perimeter of breast tissue should be evaluated during the clinical breast examination. This includes all tissue from the sternum to the inframammary ridge, to the midaxillary line, to the clavicle, and back to the sternum. (C) The pattern of examination should be systematic and performed in vertical strips to ensure all breast tissue is covered.
  • Chronic Disease In Malaysia

    1. 1. Chronic diseases in Malaysia Dr. Rashidi Ahmad MD(USM), MMed(USM), FADUSM, AM 24 th August 2008 Pantai Batu Buruk, KT
    2. 2. Objectives <ul><li>Understanding chronic diseases </li></ul><ul><li>Understanding risk factors </li></ul><ul><li>Understanding methods of prevention </li></ul>
    3. 3. Outline <ul><li>Definition </li></ul><ul><li>Significance epidemiological data </li></ul><ul><li>Overview chronic diseases in Malaysia and its risk factors </li></ul><ul><li>Discussion on few chronic diseases </li></ul>
    4. 4. Introduction <ul><li>Broad definition of chronic disease: Illnesses that are prolonged, do not resolve spontaneously, and are rarely cured completely. </li></ul><ul><li>CDC's National Center for Chronic Disease Prevention and Health Promotion: … and that are preventable, and that pose a significant burden in mortality, morbidity, and cost. </li></ul>
    5. 5. Chronic Disease Epidemic
    6. 9. Chronic Disease in US <ul><li>> 90 million Americans live with chronic dz </li></ul><ul><li>Account for 70% of all deaths </li></ul><ul><li>Account for > than 60% of the nation's medical-care costs. </li></ul><ul><li>Account for one third of the years of potential life lost before age 65 </li></ul>The Robert Wood Johnson Foundation, Annual Report 1994; Health, United States, 1994
    7. 10. Chronic Dz in M’sia <ul><li>Total deaths in Malaysia, 2002 = 119,000. </li></ul><ul><li>Total deaths related to chronic disease in Malaysia, 2002 = 85,000. </li></ul><ul><li>Chronic diseases accounted for 71% of all deaths in 2002 </li></ul>
    8. 12. Malaysia NCD Surveillance 2005/06: CD among Malaysian Adult Aged 25-64 <ul><li>The data was obtained from 2.572 subjects, with total response rate of 84.6%. </li></ul><ul><li>~ 11.6 million adults aged 25-64 years were having at least one NCD risk factor. </li></ul><ul><li>Only about 3% of Malaysian adults did not have risk factor. </li></ul>
    9. 13. Common Risk Factors
    10. 14. Overweight & obesity <ul><li>Prevalence: overweight (31.6%); obesity (16.3%). </li></ul><ul><li>Men (30.9%), women (32.4%) were overweight </li></ul><ul><li>Men (13.9%), woman (18.8%) were obese. </li></ul><ul><li>1 in 2 adults aged 25 to 64 years were either overweight or obese. </li></ul><ul><li>Indians > Malays and Chinese. </li></ul>
    11. 15. Prevalence of Obesity
    12. 16. <ul><li>Prevalence of overweight in Malaysia is expected to increase in women over the next 10 years, but remain relatively constant in men </li></ul>
    13. 17. Overweight and obesity <ul><li>Raised body mass index is a/w the possibility of early death. </li></ul><ul><li>High Tg & LDL-cholesterol, low HDL-cholesterol. </li></ul><ul><li>3 x more likely to have HPT </li></ul><ul><li>50% of Type 2 diabetics are obese. </li></ul><ul><li>Risk of breast and prostate cancer </li></ul>
    14. 19. Hypercholesterolemia <ul><li>Prevalence: 53.5%. </li></ul><ul><li>About 53.1% of men and 53.9% of women </li></ul><ul><li>1 in 2 adults aged 25-64 years had hypercholesterolemia. </li></ul><ul><li>Indians (61.3%), followed by Malays (54.7%) and Chinese (52.9%). </li></ul>
    15. 20. Prevalence of Hypercholesterolemia
    16. 22. Unhealthy diet <ul><li>The prevalence of non-meeting of dietary guideline for vegetables and fruits intake was 72.8%. </li></ul><ul><li>About 70.3% of men and 75.5% of women did not meet the dietary guideline. </li></ul><ul><li>~ 8.7 million or most adults aged 25-64 years did not meet the dietary guideline for vegetables and fruits intake. </li></ul>
    17. 23. Prevalence of Unhealthy Diet (Not enough vegetables and fruits)
    18. 24. ~ 3.1 million Malaysian (1 in 2 men and 1 in 33 women), aged 25-64 years were current smokers
    19. 25. Smoking habit <ul><li>Prevalence of current smokers was 25.5%. </li></ul><ul><li>Men (46.5%), women (3.0%) were current cigarette smokers. </li></ul><ul><li>~ 3.1 million (1 in 2 men and 1 in 33 women), aged 25-64 years were current smokers. </li></ul>
    20. 26. Prevalence of Current Smoker
    21. 28. Physical inactivity <ul><li>Prevalence: 60.1%. </li></ul><ul><li>About 55.4% of men and 65.1% of women were physically inactive. </li></ul><ul><li>~ 7.2 million or 1 in 2 for both men and women, aged 25-64 years were physically inactive. </li></ul>
    22. 29. Prevalence of Physical Inactivity
    23. 30. Diabetes mellitus <ul><li>Diabetes is a lifelong disease. </li></ul><ul><li>DM is a disease of the pancreas (an organ behind your stomach). </li></ul><ul><li>DM occurs when the pancreas does not produce any insulin or pancreas produces very little insulin or when the body does not respond appropriately to insulin </li></ul>
    24. 31. Diabetes mellitus in Malaysia <ul><li>Prevalence: 11.0%. </li></ul><ul><li>1 in 10 men and 1 in 8 women had high blood glucose. </li></ul><ul><li>Known diabetes: 543,385 </li></ul><ul><li>Newly diagnosed: 781,798 </li></ul><ul><li>Indians (20.0%), Malays (11.1%) and Chinese (7.5%). </li></ul>
    25. 34. Prevalence of Raised Blood Glucose
    26. 35. Manifestations of DM <ul><li>IDDM (type 1) </li></ul><ul><li>*Increased thirst *Increased hunger (especially after eating) *Dry mouth *Frequent urination *Unexplained weight loss *Fatigue (weak, tired feeling) *Blurred vision *Labored, heavy breathing *Loss of consciousness (rare) </li></ul><ul><li>NIDDM (type 2) </li></ul><ul><li>*Slow-healing sores or cuts *Itching of the skin (usually in the vaginal or groin area) *Yeast infections *Recent weight gain *Numbness or tingling of the hands and feet *Low blood glucose levels *Impotence or erectile dysfunction </li></ul>
    27. 36. Complications of DM
    28. 37. Risk factors <ul><li>A family history </li></ul><ul><li>Race or ethnic background </li></ul><ul><li>Being overweight & abnormal cholesterol levels </li></ul><ul><li>Hypertension </li></ul><ul><li>Age </li></ul><ul><li>Drugs: thiazides, Steroid medicines </li></ul><ul><li>Alcohol & Smoking </li></ul><ul><li>History of gestational diabetes </li></ul><ul><li>Autoimmune disease </li></ul><ul><li>Viruses  </li></ul>
    29. 38. If you are diabetic <ul><li>Balanced diet </li></ul><ul><li>Exercising regularly. </li></ul><ul><li>Maintain your blood cholesterol and triglyceride levels as near normal ranges </li></ul><ul><li>BP should not go over 130/80. </li></ul><ul><li>Taking medicine, if prescribed, and closely following the guidelines on how and when to take it. </li></ul><ul><li>Monitoring blood glucose and BP levels at home. </li></ul><ul><li>Keep to the appointments </li></ul>
    30. 39. Hypertension
    31. 40. What is hypertension? <ul><li>BP > 140 mm Hg / 90 mm Hg, measured while at rest. </li></ul><ul><li>Causes: essential or secondary HPT (10%) </li></ul><ul><li>Mostly asymptomatic. </li></ul><ul><li>The most well known symptoms are headache felt at the back of the head, dizziness, fatigue and ringing in the ears. </li></ul>
    32. 41. Hypertension in Malaysia <ul><li>Prevalence: 25.7%. </li></ul><ul><li>Men vs women - 26.3% vs 25.0%. </li></ul><ul><li>1 in 4 adults aged 25-64 years had HPT. </li></ul><ul><li>Known hypertensives: 1.4 million </li></ul><ul><li>Newly diagnosed:1.7 million. </li></ul><ul><li>Chinese (31.0%), Malays (23.4%) and Indians (21.6%). </li></ul>
    33. 42. Prevalence of Raised Blood Pressure
    34. 43. Hypertension risk factors
    35. 44. Complications of HPT
    36. 45. How can high BP can be prevented? <ul><li>Control body weight </li></ul><ul><li>Exercise regularly - 30 minutes a day </li></ul><ul><li>Limit daily intake of sodium (about 1 teaspoon of salt). </li></ul><ul><li>Take more fruits and vegetables and low fat products </li></ul><ul><li>Eat food that is rich in potassium (3,500 mg) potassium per day. </li></ul><ul><li>SAY NO to alcohol or tobacco. </li></ul><ul><li>Relaxation treatment: slow breathing exercise </li></ul>
    37. 47. Reduce high sodium food <ul><li>Processed foods such as lunch meats, sausage, bacon, and ham </li></ul><ul><li>Canned soups, bouillon, dried soup mixes </li></ul><ul><li>Condiments (ketchup, soy sauce, salad dressings) </li></ul><ul><li>Frozen and boxed mixes for potatoes, rice, and pasta, snacks (pretzels, popcorn, peanuts, chips), pickled or marinated food. </li></ul><ul><li>AJINIOMOTO (monosodium glutamate) </li></ul>
    38. 48. Increase high potassium diet
    39. 49. Heart attack
    40. 51. Risk factors
    41. 52. Stroke
    42. 53. Prevention
    43. 54. Cancer World Health Organization (WHO) International Agency for Research on Cancer: World Cancer Report 2003)
    44. 56. Who is at risk for cancer? <ul><li>Everyone </li></ul><ul><li>In the US, cancer is likely to affect 1 in 2 men and 1 in 3 women </li></ul><ul><li>The amount of risk you have depends on a few factors (tobacco use, lifestyle choices (such as diet and exercise), family history, and factors in your workplace and environment) </li></ul>
    45. 57. Workplace or environment factors? <ul><li>Exposure to the sun can cause skin cancer, and breathing tobacco smoke puts you at risk of lung cancer and some other types of cancer. </li></ul><ul><li>Carcinogenic: asbestos, solvents and chemicals used for manufacturing or cleaning, smoke or fumes from burning materials, and many others. </li></ul>
    46. 58. Cancer of prostate
    47. 60. Prostate cancer manifestations <ul><li>Weak or interrupted flow of urine. </li></ul><ul><li>Frequent urination (especially at night). </li></ul><ul><li>Trouble urinating. </li></ul><ul><li>Pain or burning during urination. </li></ul><ul><li>Blood in the urine or semen. </li></ul><ul><li>A pain in the back, hips, or pelvis that doesn't go away. </li></ul><ul><li>Painful ejaculation </li></ul>
    48. 61. How to detect?
    49. 62. Prostate-specific antigen (PSA) level: PSA is a substance produced by the prostate and some other tissues in the body Transrectal USG
    50. 63. Breast cancer
    51. 66. Techniques for breast examination. How to detect?
    52. 67. <ul><li>The New Zealand Breast Cancer Foundation recommends women between 40 and 50 have a yearly mammogram and twice yearly from 50 years. </li></ul>
    53. 68. Conclusions <ul><li>Chronic diseases is a major problem for Malaysia </li></ul><ul><li>At least 80% of premature heart disease, stroke and type 2 diabetes, and 40% of cancer could be prevented by reversing a common factors. </li></ul>
    54. 69. Common Risk Factors
    55. 71. Thank you