NCDPrevention & Control Program
PRESENTATION OUTLINES   NCD burden       Cancer & Tobacco Control Program       Violence Prevention Program       Inju...
Global CVD-Death 16.6 million (2001)                                       3
Is NCD (CVD, DM) an important health problem ?   Disease Burdens :       c   Global & Local                   How serious ...
Death, by broad cause group in year 2000             Total deaths: 55,694,000                                             ...
The Global Death due to                              Chronic Diseases (NCD)   ~60% of the 56.5 million total reported dea...
Leading Causes of Death in Rural Areas, China, 1998Communicable diseases (2.6%)Injuries (11.2%)                           ...
High Burden in Developing Countries               Lost healthy years (000‟s) from Cardiovascular disease in 2000          ...
Changes in age-adjusted mortality rate, Japan                               400                              400          ...
The proportion of lifestyle-related diseases to all death in Japan.                                                       ...
The World Health is in TransitionEpidemiological:   NCD overriding CD, & double                   burden of diseases in ma...
“The Tip of the iceberg”32 million heart attacks per year                                    12
World Health Report 2002   10 of the top risks explain a high    proportion of the premature    deaths and disease burden...
The Global Burden of                               Chronic Diseases (NCD)   ~46% of the global burden of disease (2001)  ...
NCDTHE LOCAL SITUATION                      15
NCD      THE LOCAL SITUATION       10 ++ millions-at least 1 NCD Risk Factors                              16
Common Risk Factors of Lifestyle DiseasesShare Predisposing Conditions:     Hypertension     Obesity (especially central...
18
Smoking   30.6% ever smokers   24.8% current smokers   Higher in Kelantan (31.7%), Pahang (29.8%)    and Sabah (29.3%)....
Physical Inactivity   NHMS2 – 11.6% exercised adequately, 31.7%    ever exercised   Nearly 70% of Malaysians do not exer...
Alcohol (amongst non-Muslims)   29.2% ever drank   23% current drinkers   Higher prevalence in Sabah, rural location,  ...
HYPERTENSIONIncrease of cases due to;•aging•Smoking habit•?life stressors•? Excessive dietary saltintake                  ...
MALAYSIA   NCD is leading in the 10 leading causes of    morbidity and mortality for the last few    years.   Double bur...
Epidemiological Transition Moving from a developing to a develop  status Lifestyle related diseases increase “Double bu...
25
TOTAL NUMBER OF ADMISSION (CVD)                  TOTAL NUMBER OF DEATHS (CVD)                    TO GOVERNMENT HOSPITALS  ...
TOTAL NUMBER OF ADMISSION (CVA/STROKE) TO GOVERNMENT                          HOSPITALS 1991 - 2000                       ...
Leading Causes of Diseases Burden, Malaysia 2000TOTAL DALY Status & Rank Order         One DALY = one lost year of „health...
DIABETES MELLITUS•Increasing prevalence1986 6.3%,1995 7.7%,1996 8.3%due to sedentary lifestyle, obesity andhigh fat diet. ...
Number of Diabetes Cases in            Klinik Kesihatan (2000 – 2002)                                     657958          ...
Projection of Risk Factor Burden-1Disease          Prev          1996             2002                2006      2010      ...
Projection of Risk Factor Burden -2Disease             1996                2002                2006            2010       ...
Projection of Risk Factor Burden-1Burden of Risk          Prev         1996            2002             2006        2010  ...
Projection of Risk Factor Burden -2     Diseases               Current/Latest                2005             2010        ...
% of Most Common Cancers in Penang                      by Gender, 1994-1998       MALE                                   ...
The Malaysia Health is in TransitionEpidemiological:   NCD overriding CD, &                   double burden of diseasesDem...
NCD Prevention & Control Program: Malaysia Experience
LIFESTYLES CHANGES (Individuals)Intensify Prevention and Promotion Activities    Adopt healthy lifestyle, be active    R...
Determinants of CVD (NCD)BEHAVIORALBEHAVIORAL Tobacco Tobacco Diet Diet Physical Activity Physical Activity Alcohol...
RISK FACTORSNon-modifiable risk factors:      age,sex,ethnic, genes                               Intermediate risk       ...
NCD         Prevention & Control ProgramPrograms:•   Diabetes Prevention and Control Program•   CVD Prevention and Control...
Should We Attempt To Prevent              A Chronic Disease (NCD) ?   An Important health problem   Natural history is e...
NCD Prevention & Control ProgramGeneral OBJECTIVES   To reduce morbidity and premature mortality of    NCD   To reduce N...
NCD Prevention & Control Program        Promotion       Assessment       Intervention                                  ...
LEVELS OF PREVENTIONHealthy individual       Risk factors &   Established     Complication                         Early D...
NCD Prevention & Control Program                                         ACTIVITIES   Health Promotion &                 ...
CVD (NCD) Prevention & Control ProgramPolicy and Decision MakerProgram Managers                                   Health  ...
Natural History disease and Hierarchy of Action     Under the scope of         Hospital care and     Clinical specialist  ...
Framework for the prevention and control of CVD (NCD)                         Comprehensive NCD strategy                 I...
NCD Prevention & Control ProgramSTRATEGY   Two strategies are used :     i) The population strategy     ii) The individua...
NCD Prevention & Control Program              Studies show that appropriate intervention can reduce                       ...
NCD Prevention & Control Program               Studies show that appropriate intervention can reduce                      ...
POPULATION APPROACH/STRATEGY   Aim to correct/modify underlying causes or risk    factors of NCD in the community.   To ...
NCD Prevention & Control Program                   HIGH RISK STRATEGYTarget: High risk populationActivities : Identifying...
NCD Prevention & Control Program                                         ACTIVITIES   Health Promotion &                 ...
NCD Entry point                  DIABETES           HYPERTENSION      PIKAM ProgramPROMOTION &               World Diabete...
Components of the CVD (NCD) ProgramPROMOTION &         SCREENING/        INTERVENTION         SURVEILLANCE/ EDUCATION     ...
Health Promotion        &Health Education (10 Prevention)
HEALTH PROMOTION   Incorporate into Healthy Lifestyle campaigns    - adopt healthy lifestyle    - good nutrition    - wei...
HEALTH PROMOTION   Phase 1 – 1991 to 1996         Disease oriented campaign-yearly themes   Phase 2- 1997 to 2002      ...
PHASE 1 HLSC- Disease Oriented                            1991-1996    LOVE YOUR HEART 1991                              ...
PHASE 2 HLSC - Behavioural Oriented                              1997-2002    HEALTHY EATINGRECIPE FOR GOOD HEALTH        ...
65
   World Heart Day Theme:          2000: "Exercise”          2001          2002       Nutrition, obesity and physical ...
PARTNERS IN CVD:                     NGO, INDUSTRY•   1. Working closely with agencies, NGO:      -Heart Foundation, Hyper...
ScreeningHealth Assessment
CARDIOVASCULAR DISEASES ACTIVITIES   CVD Risk Factors Screening (1999)    - plan to be incorporated into Well-Adult Clini...
My HeSS (2004)                  My Health Status Surveillance   An Initiative   An assessment tools/ enabler:          ...
What MyHeSS offers ?       TOOLS            DETECTIONQuestionnaire       Risk Factors:           INTERVENTIONPhysical     ...
CVD (NCD) Prevention & Control ProgramPolicy and Decision MakerProgram Managers                                   Health  ...
My Health Surveillance System (MyHeSS)  Socio-           Health      Physical        Stress             Dietdemography    ...
INTERVENTIONBehavioral Modification  Pharmacotherapy    Surgical, etc.
Intervention   Physical activity   Quit smoking   Healthy diet   Avoid alcohol   Handle stress   Weight reduction   ...
CVD (NCD) Prevention & Control ProgramPolicy and Decision MakerProgram Managers                                   Health  ...
InterventionHealth Clinic:    Prevention :10 20 30   Hypertension clinic   Diabetes clinic   NCD clinic (2004)Hospital ...
INTERVENTION   PIKAM       Malaysia Cardiovascular        Intervention Project (2000/2001)       Malaysia Cardiovascula...
CLINICAL PRACTISE GUIDELINES   CPG on The Management of Hypertension 2002   CPG for Treatment of Tobacco Smoking and Dep...
Appropriate facilities and equipments   NCD Resource Center        At district/clinics        Manpower, machine,       ...
TRAINING for Diabetes Program•     Short term    •   3 days diabetes management courses for paramedic from        PHCs.   ...
EVALUATION :                            Audit & Research   MyHeSS           NCD Risk Factor Study           Physical Ac...
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Prevention of Non-Communicable Diseases in Malaysia

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Prevention of Non-Communicable Diseases in Malaysia

  1. 1. NCDPrevention & Control Program
  2. 2. PRESENTATION OUTLINES NCD burden  Cancer & Tobacco Control Program  Violence Prevention Program  Injury Prevention Program  Diabetes Prevention & Control Program  CVD Prevention & Control Program  Blindness Prevention & Control Program  NCD Surveillance 2
  3. 3. Global CVD-Death 16.6 million (2001) 3
  4. 4. Is NCD (CVD, DM) an important health problem ? Disease Burdens : c Global & Local How serious is the problem ? 4
  5. 5. Death, by broad cause group in year 2000 Total deaths: 55,694,000 Non-communicable Injuries (9.1%) conditions (59.0%)Communicable diseases, maternal and perinatal conditions and nutritional deficiencies (31.9%) 5 Source: WHO, World Health Report 2001
  6. 6. The Global Death due to Chronic Diseases (NCD) ~60% of the 56.5 million total reported deaths in the world (2001)  CVD -16.6 millions : 7 million CHD, 4.5 millions Stroke  DM with complication- 4 millions  COPD -2.7 millions Expected to increase to ~70% by 2020  Developing countries:  71% - IHD  75% - stroke  70% - diabetes 6 The world health report 2002: reducing risk, promoting healthy life. Geneva, World Health Organization,2002
  7. 7. Leading Causes of Death in Rural Areas, China, 1998Communicable diseases (2.6%)Injuries (11.2%) Undiagnosed (3.3%)Non-communicableconditions (82.9%)Noncommunicable conditions 7 Source: Ministry of Health, China, 2000
  8. 8. High Burden in Developing Countries Lost healthy years (000‟s) from Cardiovascular disease in 2000 5,000 10,000 15,000 20,000 25,000 30,000 SEAR DWPR B (CHN,VTN, MAL) EUR C EUR A EUR B EMR D AMR A Ischaemic heart disease AMR B Stroke SEAR B AFR E Other cardiovascular dis AFR D EMR B WPR A (JPN) Source: World Health Report, 2002 AMR D 8
  9. 9. Changes in age-adjusted mortality rate, Japan 400 400 1965 Stroke 350 350 Heart disease Tuberculosis 300age adjusted mortality ( /100,000) 300 Pneumonia, Males Cancer Females Br o n c h i t i s 1965 250 250 200 200 150 150 100 100 50 50 0 0 47 50 55 60 65 70 75 80 85 90 95 47 50 55 60 65 70 75 80 85 90 95 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 year year 9
  10. 10. The proportion of lifestyle-related diseases to all death in Japan. About 60% others cancer 38.2 31.0% % Cardiovascular disease stroke 15.3% 13.6%hypertension 0.6% diabetes 10 1.3% (2001)
  11. 11. The World Health is in TransitionEpidemiological: NCD overriding CD, & double burden of diseases in many developing countriesDemographic: Population ageingLifestyles: Diets are rapidly changing Physical activity reducing Tobacco use increasingUrbanization: Growing citiesGlobalisation: Increasing global influences
  12. 12. “The Tip of the iceberg”32 million heart attacks per year 12
  13. 13. World Health Report 2002 10 of the top risks explain a high proportion of the premature deaths and disease burden 7 are related to diet and physical activity One third of the disease burden is due to 5 risk factors Concentrating on a few key major RF will have a big impact 13
  14. 14. The Global Burden of Chronic Diseases (NCD) ~46% of the global burden of disease (2001)  DM – 177 millions Expected to increase to 57% by 2020  Diabetes > 2.5 fold increased  84 million (1995) to 228 million (2025) 14 The world health report 2002: reducing risk, promoting healthy life. Geneva, World Health Organization,2002
  15. 15. NCDTHE LOCAL SITUATION 15
  16. 16. NCD THE LOCAL SITUATION 10 ++ millions-at least 1 NCD Risk Factors 16
  17. 17. Common Risk Factors of Lifestyle DiseasesShare Predisposing Conditions:  Hypertension  Obesity (especially central obesity)  Diabetes Mellitus  CancerAnd Common Risk Factors:  Tobacco  Physical Inactivity  Irrational Diet (especially high fat intake)  Alcohol over-consumption 17
  18. 18. 18
  19. 19. Smoking 30.6% ever smokers 24.8% current smokers Higher in Kelantan (31.7%), Pahang (29.8%) and Sabah (29.3%). Lowest in Penang (20.7%) Higher amongst Malay, rural, males (females only 3.5%) 19
  20. 20. Physical Inactivity NHMS2 – 11.6% exercised adequately, 31.7% ever exercised Nearly 70% of Malaysians do not exercise 20
  21. 21. Alcohol (amongst non-Muslims) 29.2% ever drank 23% current drinkers Higher prevalence in Sabah, rural location, males. 21
  22. 22. HYPERTENSIONIncrease of cases due to;•aging•Smoking habit•?life stressors•? Excessive dietary saltintake 22
  23. 23. MALAYSIA NCD is leading in the 10 leading causes of morbidity and mortality for the last few years. Double burdens in term of disease pattern: Preexisting infectious diseases and emerging of NCD problem. 23
  24. 24. Epidemiological Transition Moving from a developing to a develop status Lifestyle related diseases increase “Double burden” of the disease 24
  25. 25. 25
  26. 26. TOTAL NUMBER OF ADMISSION (CVD) TOTAL NUMBER OF DEATHS (CVD) TO GOVERNMENT HOSPITALS IN GOVERNMENT HOSPITALS 1985 - 1998 1965 -2000120000 103512 108087 104751100000 80000 58961 60000 40000 20000 0 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 Admission 27
  27. 27. TOTAL NUMBER OF ADMISSION (CVA/STROKE) TO GOVERNMENT HOSPITALS 1991 - 2000 Year Hospital Admission Death 1991 8,037 2,18316000 1992 9,033 2,41614000 1993 9,420 2,33812000 1994 10,132 2,49010000 1995 11,422 2,6358000 1996 12,365 2,610 1997 12,985 2,7906000 1998 14,047 2,8224000 1999 12,416 2,6742000 2000 13,868 2,801 0 91 92 93 94 95 96 97 98 99 2000 Sumber: Unit Sistem Dokumentasi dan informasi-KKM 2002 28
  28. 28. Leading Causes of Diseases Burden, Malaysia 2000TOTAL DALY Status & Rank Order One DALY = one lost year of „healthy‟ lifeRank No DALY Total % Total1 Ischaemic Heart Diseases 278,733 9.8%2 All mental illness 206,898 7.3%3 Cerebro-vascular Disease/stroke 180,431 6.4%4 Road Traffic Injuries 162,736 5.7%5 All cancers 137,675 4.9%6 Septicemia 127,714 4.5%7 Diabetes Mellitus 103,449 3.7%8 Acute Lower Respiratory tract infections 87,539 3.1%9 Hearing loss 83,560 3.0%10 Other respiratory disease 82,032 2.9%11 Asthma 61,005 2.2%12 Chronic obstructive pulmonary disease 60,728 2.1%13 Cirrhosis 54,687 1.9%14 Other cardiovascular diseases 51,315 1.8% 29
  29. 29. DIABETES MELLITUS•Increasing prevalence1986 6.3%,1995 7.7%,1996 8.3%due to sedentary lifestyle, obesity andhigh fat diet. 30
  30. 30. Number of Diabetes Cases in Klinik Kesihatan (2000 – 2002) 657958 525858 446847Year 2000 Year 2001 Year 2002 31
  31. 31. Projection of Risk Factor Burden-1Disease Prev 1996 2002 2006 2010 2020Burden Rate NHMS2HPT 29.9% 2,190,504 2,631,500 2,850,000 2,987,900 3,557,400DM 8.3% 608,000 730,490 790,400 829,400 987,500Stroke* 12,365IHD* 33,070 Note: Based on NHMS2 1996. Prevalance rate remain constant. Disease Burden= Pi x [p0 + (pi x Td)] 32
  32. 32. Projection of Risk Factor Burden -2Disease 1996 2002 2006 2010 2020Burden NHMS2HPT 2,190,504 3,476,435 4,383,450 5,226,300 8,126,100 (29.9%) (39.5%) (45.9%) (52.3%) (68.3%)DM 608,000 836,200 983,650 1,109,200 1,558,600 (8.3%) (9.5%) (10.3%) (11.1%) (13.1%) Note: Based on NHMS2 1996. Prevalence rate increase proportionately. 33
  33. 33. Projection of Risk Factor Burden-1Burden of Risk Prev 1996 2002 2006 2010 2020FactorSmoking 24.8% 1,816,900 2,182,700 2,368,400 2,478,300 2,950,600Obesity 4.6% 322,348 387,248 420,200 459,700 547,300Overweight 16.6% 1,216,326 1,460,982 1,585,300 1,658,800 1,957,000Physical 88.4% 6,476,300 7,780,200 8,442,200 8,853,700 10,597,000InactivityIGT 4.3% 315,022 378,447 410,650 429,700 511,600Alcohol 23% Note: Based on NHMS2 1996. Prevalence rate remain constant. Disease Burden= Pi x [p0 + (pi x Td)] 34
  34. 34. Projection of Risk Factor Burden -2 Diseases Current/Latest 2005 2010 2020 2002Cancers (All forms) 26,089 cases 27,840 30,883 38,021 (NCR 2002) Assumptions: 1. Population growth at 2.1% yearly is constant with similar growth in number of males and females 2. Incidence rate of cancer remain constant in both sexes 36
  35. 35. % of Most Common Cancers in Penang by Gender, 1994-1998 MALE FEMALE Lung (20.2%)  Breast (24.4%) Colorectal (10.6%)  Cervix (12.2%) Nasopharynx ( 8.5%)  Colorectal ( 8.7%) Stomach ( 8.0%)  Lung ( 5.8%) Liver ( 5.0%)  Ovary ( 4.9%) Prostate ( 4.6%)  Stomach ( 4.5%) Source: Penang Cancer Registry report 1994-1998 37
  36. 36. The Malaysia Health is in TransitionEpidemiological: NCD overriding CD, & double burden of diseasesDemographic: Population ageing : Increasing life expectancyLifestyles: Diets are rapidly changing - High fat, low fiber, high salt Physical activity reducing Tobacco use increasing AlcoholicUrbanization: Growing cities : pollutionGlobalisation: Increasing global influences increased trade- foodstuffs, tobacco
  37. 37. NCD Prevention & Control Program: Malaysia Experience
  38. 38. LIFESTYLES CHANGES (Individuals)Intensify Prevention and Promotion Activities  Adopt healthy lifestyle, be active  Regular Exercise  Eat Right – Low Sugar, Low Salt, Low Fat, High Fibre.  No Smoking, No Alcohol 40
  39. 39. Determinants of CVD (NCD)BEHAVIORALBEHAVIORAL Tobacco Tobacco Diet Diet Physical Activity Physical Activity Alcohol AlcoholENVIRONMENTALENVIRONMENTAL INTERMEDIATE INTERMEDIATE END-POINTS Socio-cultural Socio-cultural RISK FACTORS RISK FACTORS END-POINTS Ischemic Heart Dis. Policy Policy Hypertension Hypertension Ischemic Heart Stroke Dis. Economic Economic Blood lipids Diabetes Peripheral Vasc. Dis. Stroke Physical Physical Obesity Diabetes Cancer Peripheral Vasc.NON-MODIFIABLENON-MODIFIABLE Blood lipids Obesity Chronic Lung Dis. Dis. Age, Sex, Genes Age, Sex, Genes 41
  40. 40. RISK FACTORSNon-modifiable risk factors: age,sex,ethnic, genes Intermediate risk factors: END POINTSBehavioural risk factors: hypertension CHD smoking blood lipids alcohol Stroke obesity diet overweight PVD physical activity Cancers diabetes stress COPD depression Emphysema Mental conditionSocio-economic risk factor:Cultural & environment 42
  41. 41. NCD Prevention & Control ProgramPrograms:• Diabetes Prevention and Control Program• CVD Prevention and Control Program• Blindness Prevention and Control Program• Injury Prevention and Control Program• Violence Intervention Program• Substance Abuse Program• Non-Communicable Disease Surveillance
  42. 42. Should We Attempt To Prevent A Chronic Disease (NCD) ? An Important health problem Natural history is established Early detection test available Effective intervention Cost effective program 44
  43. 43. NCD Prevention & Control ProgramGeneral OBJECTIVES To reduce morbidity and premature mortality of NCD To reduce NCD modifiable risk factors such as hypertension, smoking, hypercholesterolemia, diabetes mellitus, obesity and physical inactivity in the community. To improve the quality of life of people with NCD 45
  44. 44. NCD Prevention & Control Program  Promotion  Assessment  Intervention 46
  45. 45. LEVELS OF PREVENTIONHealthy individual Risk factors & Established Complication Early Disease DiseaseHealth Specific Disability RehabPromotion Protection Screening Early Detections & App RxPrimary Prevention Secondary Prevention Tertiary Prevention 47
  46. 46. NCD Prevention & Control Program ACTIVITIES Health Promotion &  To prevent risk factors Health Education  To prevent diseases Screening /assessment  To identify Risk factors  To diagnose diseases Intervention:  To control diseases :  appropriate treatment - treat at the earliest possible stage  Behavioral modification - slow disease progression  Pharmacotherapy  Surgical , etc  To prevent complications  rehabilitation  To limit disability at the earliest possible stage  To restore an affected individual to a useful, satisfying & when possible, self sufficient role in society Evaluation / audit / surveillance Capacity building Inter & intra sectoral coordination and collaboration : smart partnership 48
  47. 47. CVD (NCD) Prevention & Control ProgramPolicy and Decision MakerProgram Managers Health Promotion & Education Evaluation: HealthAudit & Research Assessment Customized personalised INTERVENTION: Behavior Modification Pharmacotherapy Customized, personalised, self-empowerment, family & community involvement 49
  48. 48. Natural History disease and Hierarchy of Action Under the scope of Hospital care and Clinical specialist Severe Apparent follow up form diseases Primary care Mild form MildUnder the scope ofpublic health Physician form Secondary Remove causes prevention Unapparent and risk diseases Eradicate Primary Eliminate prevention Pathogenesis started Reduce burden Pathogenesis Occur Exposure Control Early detection Availability of disease determinants 50
  49. 49. Framework for the prevention and control of CVD (NCD) Comprehensive NCD strategy Integrated national NCD plans; STEPS surveys Direction & Infrastructure Changing Changing Reorienting Environments Lifestyles Health Services Model community-based prevention programs Evidence-based guidelines;Demonstration NCD prevention & control projects Capacity-building 51
  50. 50. NCD Prevention & Control ProgramSTRATEGY Two strategies are used : i) The population strategy ii) The individual or high risk strategy. They are complementary and reduction of Cardiovascular diseases are likely to be most successful where both are pursued simultaneously. 52
  51. 51. NCD Prevention & Control Program Studies show that appropriate intervention can reduce the morbidity and mortality due NCD High Risk & Population approachesPOPULATION ApproachTarget: General populationAim to correct/modify underlyingcauses or risk factors of CVD inthe community.To lower the mean of risk factorsand to shift the whole distributionof exposure in favourable Reduce a small amount of risk in adirection large number of people (e.g. reduce salt intake - promoting healthy lifestyle). Lifestyle change plus environmental approach. 53
  52. 52. NCD Prevention & Control Program Studies show that appropriate intervention can reduce the morbidity and mortality due NCD High Risk & Population approaches + Truncate high risk end of Reduce a small amount of risk in a exposure distribution (e.g. large number of people (e.g. reduceorganise an obesity clinic or a salt intake). quit smoking clinic). Lifestyle change plus environmental Clinical approach to disease approach. prevention. 54
  53. 53. POPULATION APPROACH/STRATEGY Aim to correct/modify underlying causes or risk factors of NCD in the community. To lower the mean of risk factors and to shift the whole distribution of exposure in favourable direction 55
  54. 54. NCD Prevention & Control Program HIGH RISK STRATEGYTarget: High risk populationActivities : Identifying high risk individual:  CVD screening programme  Health Status Surveillance (My HeSS) Appropriate management of the risk factors 56
  55. 55. NCD Prevention & Control Program ACTIVITIES Health Promotion &  To prevent risk factors Health Education  To prevent diseases Screening /assessment  To identify Risk factors  To diagnose diseases Intervention:  To control diseases :  appropriate treatment - treat at the earliest possible stage  Behavioral modification - slow disease progression  Pharmacotherapy  Surgical , etc  To prevent complications  rehabilitation  To limit disability at the earliest possible stage  To restore an affected individual to a useful, satisfying & when possible, self sufficient role in society Evaluation / audit / surveillance Capacity building Inter & intra sectoral coordination and collaboration : smart partnership 57
  56. 56. NCD Entry point DIABETES HYPERTENSION PIKAM ProgramPROMOTION & World Diabetes Day Awareness week World Heart Day EDUCATION SCREENING Diabetes Clinic Hpt Clinic CVD screening Behavior BehaviorINTERVENTION PIKAM Packages Diabetes CPG Hpt CPG Audit Audit Surveillance EVALUATION Research: SDM Research Research 58
  57. 57. Components of the CVD (NCD) ProgramPROMOTION & SCREENING/ INTERVENTION SURVEILLANCE/ EDUCATION ASSESSMENT Behavior & Phm EVALUATIONHealthy Lifestyle My HeSS Guidelines My HeSS Campaign Health provider Developed Demonstration Individual/ PHC staff is being National Survey Project Family trained IEC plus Env. community Quality is Audited Audit/HSR Interventions POLICY MAKER INTERSECTORAL SMART COLLABORATIONPROG. MANAGER COMMITTEE PARTNERSHIP 59
  58. 58. Health Promotion &Health Education (10 Prevention)
  59. 59. HEALTH PROMOTION Incorporate into Healthy Lifestyle campaigns - adopt healthy lifestyle - good nutrition - weight reduction - increase physical activity 61
  60. 60. HEALTH PROMOTION Phase 1 – 1991 to 1996  Disease oriented campaign-yearly themes Phase 2- 1997 to 2002  Behavioral oriented- yearly themes Phase 3- 2003 to 2008  Behavioral oriented -2 yearly  Focus to special target groups : school children, work place  4 elements: Physical activity, diet, smoking, stress 62
  61. 61. PHASE 1 HLSC- Disease Oriented 1991-1996 LOVE YOUR HEART 1991  CLEAN FOOD, HEALTHY FAMILY 1993 AIDS KILL 1992 HEALTHY CHILDREN. STAY AHEAD PREVENT DIABETES THE NATIONS FUTURE OF CANCER 1996 1994 1995 63
  62. 62. PHASE 2 HLSC - Behavioural Oriented 1997-2002 HEALTHY EATINGRECIPE FOR GOOD HEALTH 1997 EXERCISE 1998 PREVENT INJURY 1999 ADOPT A HEALTHY LIFESTYLE PRACTISE GOOD MENTAL HEALTH TOWARDS A HARMONIOUS 2000 AND HEALTHY FAMILY 2001 64
  63. 63. 65
  64. 64.  World Heart Day Theme:  2000: "Exercise”  2001  2002 Nutrition, obesity and physical activity  2003: women, heart diseases and stroke  2004: children, adolescent and heart disease Partners: 66
  65. 65. PARTNERS IN CVD: NGO, INDUSTRY• 1. Working closely with agencies, NGO: -Heart Foundation, Hypertension Soc., MASSO etc.• 2. Organize with MOH in the following area:  NCD Resource centre (CVD/DM)  Health Promotion and education  Training 67
  66. 66. ScreeningHealth Assessment
  67. 67. CARDIOVASCULAR DISEASES ACTIVITIES CVD Risk Factors Screening (1999) - plan to be incorporated into Well-Adult Clinic & Life- Time Health Record ( LHR ) - Initially one center per district - Screening of : Body Mass Index (BMI) for Obesity : Blood Pressure : Blood Glucose for Diabetes : Blood Cholesterol : Smoking Status : Family History of Heart Disease 69
  68. 68. My HeSS (2004) My Health Status Surveillance An Initiative An assessment tools/ enabler:  Socio-demography  Health Assessment :  medical & life style history : smoking, diet, alcohol, DM, Hpt  Clinical : weight, BMI, BP, body composition  Biochemical : glucose & lipid profiles  Physical fitness Assessment (ACSM)  Diet Assessment & Management  Stress Assessment 70
  69. 69. What MyHeSS offers ? TOOLS DETECTIONQuestionnaire Risk Factors: INTERVENTIONPhysical - SmokingBiochemical - Hypertension Behavioral Mod. - Obesity - Dyslipidemia Pharmacotherapy - IGT/Diabetes To prevent:Fitness CVDDiet Fitness level HypertensionStress Dietary pattern Diabetes Stress level & coping Stroke (CVA) Cancer 71
  70. 70. CVD (NCD) Prevention & Control ProgramPolicy and Decision MakerProgram Managers Health Promotion & Education Evaluation: HealthAudit & Research Assessment My Health Status Surveillance System Customized personalised INTERVENTION: Behavior Modification Pharmacotherapy Customized, personalised, self-empowerment, family & community involvement 72
  71. 71. My Health Surveillance System (MyHeSS) Socio- Health Physical Stress Dietdemography Assessment Fitness Assessment Management Profile Module Module Module Module NCD Surveillance Database Analysis Report Intervention
  72. 72. INTERVENTIONBehavioral Modification Pharmacotherapy Surgical, etc.
  73. 73. Intervention Physical activity Quit smoking Healthy diet Avoid alcohol Handle stress Weight reduction 75
  74. 74. CVD (NCD) Prevention & Control ProgramPolicy and Decision MakerProgram Managers Health Promotion & Education Evaluation: HealthAudit & Research Assessment My Health Status Surveillance System Customized personalised INTERVENTION: Behavior Modification Pharmacotherapy Customized, personalised, self-empowerment, family & community involvement 76
  75. 75. InterventionHealth Clinic: Prevention :10 20 30 Hypertension clinic Diabetes clinic NCD clinic (2004)Hospital Prevention: 20 30 77
  76. 76. INTERVENTION PIKAM  Malaysia Cardiovascular Intervention Project (2000/2001)  Malaysia Cardiovascular Intervention Program  Behavioral Modification modules for :  Physical activity  Diet  Smoking  Hypertension  Obesity  IGT / DM  Dyslipdemia  Stress 78
  77. 77. CLINICAL PRACTISE GUIDELINES CPG on The Management of Hypertension 2002 CPG for Treatment of Tobacco Smoking and Dependence 2003 CPG on Management of Obesity 2003 CPG on Dyslipidaemia 2003 Consensus Statement on The Management of Ischemic Stroke 2000 CPG on Myocardial Infarction 2001 CPG on Heart Failure 2000 79
  78. 78. Appropriate facilities and equipments NCD Resource Center  At district/clinics  Manpower, machine, materials & management 80
  79. 79. TRAINING for Diabetes Program• Short term • 3 days diabetes management courses for paramedic from PHCs. • 3 months courses for diabetes nurses and MA of diabetes team • Refresher courses for doctors. • 6 months courses for diabetes management. • Special courses in Diabetic foot, diabetes retinopathy and nephropathy. Long term • Diabetologist. • Dietitian. • Podiatrist. 81
  80. 80. EVALUATION : Audit & Research MyHeSS  NCD Risk Factor Study  Physical Activity Study  Physical Fitness Study  Diet Study  Stress Study  NCD Surveillance in the Community  Work Place related Disease Audit for Hypertension & Diabetes Mx NCD Research Hypertension Registry (Hi-Trax) Diabetes Registry 82
  81. 81. Thank You

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