MOH Research Initiatives on NCDs
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MOH Research Initiatives on NCDs

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Paper presented at the International Research Symposium on Population Health 2013, 20 November 2013, Kuala Lumpur

Paper presented at the International Research Symposium on Population Health 2013, 20 November 2013, Kuala Lumpur

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MOH Research Initiatives on NCDs MOH Research Initiatives on NCDs Presentation Transcript

  • Ministry of Health Malaysia MOH Research Initiatives on Non-Communicable Diseases Feisul Idzwan Mustapha MBBS, MPH, AM(M) Public Health Specialist Disease Control Division, Ministry of Health, Malaysia International Research Symposium on Population Health 2013 20 November 2013 University Malaya, Kuala Lumpur dr.feisul@moh.gov.my
  • Seven Strategies: 1. 2. 3. 4. National Strategic Plan for Non-Communicable Diseases (NSP-NCD) 2010-2014 • • • • 5. 6. 7. Prevention and Promotion Clinical Management Increasing Patient Compliance Action with NGOs, Professional Bodies & Other Stakeholders Monitoring, Research and Surveillance Capacity Building Policy and Regulatory interventions Presented and approved by the Cabinet on 17 December 2010. Provides the framework for strengthening NCD prevention & control program in Malaysia. Adopts the “whole-of-government” and “whole-of-society approach”. Diabetes & obesity are used as the entry points. 2
  • Strategy 7: Policy & Regulatory Interventions • Main thrust of NSP-NCD • Health promotion and education will increase awareness and knowledge • However changes in behaviour is strongly influenced by our living environment Awareness Knowledge Health promotion & educations Behavioural Change Supportive living environment Policies & regulations 3
  • 4
  • 65th World Health Assembly (May 2012): Decided to adopt a global target of a 25% reduction in premature mortality from NCD by 2025. 66th World Health Assembly (May 2013): Adoption of the Global Action plan for the Prevention and Control of NCDs (2013-2020), including 25 NCD indicators with 9 voluntary global targets. 5
  • Global Monitoring Framework for NCDs Indicator Targets 1. Premature mortality from NCD 25% relative reduction in risk of dying 2. Harmful use of alcohol 10% relative reduction 3. Physical inactivity 10% relative reduction 4. Salt intake 30% relative reduction in mean population intake 5. Tobacco use 30% relative reduction 6. Hypertension Contain the prevalence 7. Diabetes & obesity Contain the prevalence 8. Drug therapy to prevent heart attacks & strokes At least 50% of eligible people receive therapy 9. Essential NCD medicines & basic technologies to treat major NCDs Availability & affordability Note: Targets for year 2025, against baseline of year 2010. Reporting to the United Nations every five years (next will be in 2015) 6
  • Cost effective NCD interventions… • What works, what can we afford, and what should we adopt? • The challenge? Identify interventions that: • are effective; • can lead to measurable declines in NCD death rates quickly (e.g. over 10 years); • are affordable; and • can easily be implemented and sustained. The Lancet. December 8, 2007 Volume 370: Gaziano T, Galea G and Reddy K. Scaling up interventions for chronic disease prevention: the evidence. pp 1939-1946. The Lancet. December 15, 2007. Volume 370: Asaria P, Crisholm D, Mathers C, Ezzati M, Beaglehole R. Chronic disease prevention: health effects and financial costs of strategies to reduce salt intake and control tobacco use. pp 2044-2053. Lim S, et. al. Prevention of cardiovascular disease in high-risk individuals in low-income and middleincome countries: health effects and costs. pp 2054-2061. 7
  • Cost effective interventions to address NCDs Population-based interventions addressing NCD risk factors - Excise tax increases Smoke-free indoor workplaces and public places Health information and warnings about tobacco Bans on advertising and promotion Harmful use of alcohol - Excise tax increases on alcoholic beverages Comprehensive restrictions and bans on alcohol marketing Restrictions on the availability of retailed alcohol Unhealthy diet and physical inactivity Individual-based interventions addressing NCDs in primary care Tobacco use - Salt reduction through mass media campaigns and reduced salt content in processed foods Replacement of trans-fats with polyunsaturated fats Public awareness programme about diet and physical activity Cancer - Prevention of liver cancer through hepatitis B immunization Prevention of cervical cancer through screening (visual inspection with acetic acid [VIA]) and treatment of pre-cancerous lesions CVD and diabetes - Multi-drug therapy (including glycaemic control for diabetes mellitus) for individuals who have had a heart attack or stroke, and to persons at high risk (> 30%) of a cardiovascular event within 10 years Providing aspirin to people having an acute heart attack - - 8
  • “My Body is Fit aand Fabulous” An Implementation Research (qualitative + quantitative approaches) MyBFF@school MyBFF@home INTERVENTION PROGRAMMES TO COMBAT OBESITY IN MALAYSIA Slide courtesy of Dr Wan Nazaimoon, IMR; nazaimoon@gmail.com MyBFF@work 9
  • MyBFF@school • MyBFF@school consists of: • Small-sided football games (SSG), Intensified nutrition intervention. • Psychology motivation - SELF-EMPOWERMENT. • Peer support from members of the KELAB DOKTOR MUDA & PROSTAR). • Involvement of teachers, parents as agent of change. • Study sites: Selected schools in Putrajaya (standards 4, 5 & Form 1 & 2). • Have already obtained approval from MOE for the additional school hours required. Slide courtesy of Dr Wan Nazaimoon, IMR; nazaimoon@gmail.com 10
  • MyBFF@home • An intervention study to combat obesity among housewives in Klang Valley. • Primary aim (Phase I) • To develop an intervention package for overweight and obese housewives aged 18-59 years old. • Secondary aim (Phase II) • To determine the effectiveness of the intervention package in reducing body weight among overweight and obese housewives. • A proposed “package” has been developed • 3 main components (i) diet; (ii) exercise & physical activity; and (iii) self-monitoring behaviour. Slide courtesy of Dr Wan Nazaimoon, IMR; nazaimoon@gmail.com 11
  • MyBFF@work • An Intervention Study to Combat Obesity among Government Employees in Kelantan. • Collaboration with USM. • General Objective: To provide low cost, feasible and goaldirected, process-oriented weight loss program for overweight and obese Malaysian civil servants. 12 Slide courtesy of Dr Wan Nazaimoon, IMR; nazaimoon@gmail.com
  • JOM MAMA Opportunity Focus on pre-pregnancy for prevention 1. New DOHaD science indicates that pre-pregnancy offers opportunity for prevention of diabetes and other NCDs 2. Increasing levels of obesity and hypertension in women of reproductive age 3. Pre-pregnancy overweight approximately doubles the risk for hypertensive disorders, preeclampsia and gestational diabetes. Overweight and obesity increase the risk of stillbirths, obstetric intervention, postpartum hemorrhage, and birth defects2. 4. Pre-pregnancy health status affects both the shortterm and long-term health 5. Women enter pregnancy with modifiable risk factors 1: Hanson MA & Gluckman PD. Developmental origins of noncommunicable disease: Population and public health implications. American Journal of Clinical Nutrition 2011; 94(6 Suppl.): 1754S1758S. 2: Zulfiqar A bhutta, Sohni V Dean, Ayesha Imam, Zohra S Lassi: Systematic review of Preconception risks and interventions; WHO report : 32-33 13 Slide courtesy of Priya Matzen, Novo Nordisk; pryn@novonordisk.com
  • JOM MAMA: Objective What we want to do To investigate if prepregnancy interventions improves young couples health literacy and women’s health Prevent/ reduce risk of NCDs To assess if the intervention improves delivery and birth outcomes. 14 Slide courtesy of Priya Matzen, Novo Nordisk; pryn@novonordisk.com
  • JOM MAMA: Approach Evidence base Pre-conception / young couples Malaysia Nurul (25) & Khairil (27) Academia/Partners Implementation Public-private partnership Phase 1 Co-creatIon Phase 2 Phase 3 Programme development Monitoring and Evaluation 15 Slide courtesy of Priya Matzen, Novo Nordisk; pryn@novonordisk.com
  • South East Asia Community Observatory SEACO: Research for a healthy community v D.D. Reidpath & P. Allotey 16
  • Vision To develop a world class research and training site providing high quality infrastructure for conducting community based “whole of life research” that informs internationally, nationally, and locally relevant, priority questions related to population health and wellbeing. Mission SEACO will achieve its vision through the collection and sharing of high quality data and methods. The protection of, and service to the communities involved with SEACO is paramount. Slide courtesy of Prof. Pascale Allotey, Monash University Sunway Campus; pascale.allotey@monash.edu 17
  • DHSS: A Research Platform SEACO: A research platform • A community-based sentinel surveillance system that captures longitudinally, a fully enumerated population within circumscribed geographical location. • The data collection process explicitly captures information on demography, morbidity and mortality from the individual, within the context of the household, and the household within the context of the community, as well as the physical, social, geographical relationships between these. 18 Slide courtesy of Prof. Pascale Allotey, Monash University Sunway Campus; pascale.allotey@monash.edu
  • SEACO: Study types Family, Community and Population Dynamics Nested crosssectional studies MCH Cause of Death Nested longitudinal studies Rural-Urban migration 19 Slide courtesy of Prof. Pascale Allotey, Monash University Sunway Campus; pascale.allotey@monash.edu
  • HOPE-4 Study • Intervening the epidemiologic transition through innovative means of controlling hypertension • Collaboration between UiTM, NCD MOH, McMaster University, Toronto University and London School of Hygiene & Tropical Medicine • Grand Alliance for Chronic Diseases, supported by Grand Challenges Canada. • Blood pressure is the biggest global risk factor for NCDs, followed by tobacco, alcohol and poor diet (Richard Horton, Lancet 2012; 380:2053-54. Information courtesy of Prof. Dato’ Dr Khalid Yusoff, kyusoff@salam.uitm.edu.my 20
  • HOPE-4 Study • 50 communities in Malaysia, Columbia, India and Sub-Sahara Africa. • Task shifting – non-physician healthcare workers under supervision of doctors. • Use of polypill. • Objective: Develop, implement and evaluate a CVD risk assessment, treatment and control program. • Primary outcome: composite CV events • CV deaths, MI, stroke, CHF, hospitalisation, revascularisation. 21 Information courtesy of Prof. Dato’ Dr Khalid Yusoff, kyusoff@salam.uitm.edu.my
  • Potential policy interventions to improve dietary intake for preventing obesity in Malaysia Policy areas Fiscal 1. 2. 3. 4. 5. Primary production and imports 1. 2. 3. Food processing 1. 2. Potential policy interventions Removal of subsidies on sugar, for both industries and households. Removal of subsidies on cooking oil, for both industries and households. Introduce subsidies for fruits and vegetables. Introduce excise and/or sales tax on soft drinks. Introduce excise and/or sales tax on sweetened condensed milk. Incentives for farmers to grow local fruit and vegetable. Reducing import duty on fruits and vegetables. Increasing import duty on cooking oils and other fat sources (e.g. butter, ghee). Regulate maximum content of sugar and fat in processed food products. Incentives (e.g. Healthy Choice endorsement) for industries to improve food composition. 22 This policy-mapping analysis grid is adapted from G. Sacks, B. Swinburn & M. Lawrence: Obesity Policy Action framework and analysis grids for a comprehensive policy approach to reducing obesity. Obesity Reviews (2008)
  • Potential policy interventions to improve dietary intake for preventing obesity in Malaysia Policy areas Food marketing / information 1. 2. 3. 4. 5. Potential policy interventions Comprehensive restrictions for all marketing of unhealthy food to children under 16 years in all media, including television, the internet and other electronic media. Introduce a nutrition signposting system (Healthy Choice tick, keyhole or traffic light labelling) as a front pack labelling to indicate food products with less fat, sugar and salt, and more whole grain and fibre. Banning television advertising of foods high in fat and/or high in sugar during prime time viewing (7pm to 9pm). Mandatory for fast food outlets to display nutrition information about each product on menus, menu boards and drive-through boards at the point of sale, and on tags next to self-service cabinets and food displays. Mandatory for vending machine operators to display nutrition information about the products at the front of vending machines. 23 This policy-mapping analysis grid is adapted from G. Sacks, B. Swinburn & M. Lawrence: Obesity Policy Action framework and analysis grids for a comprehensive policy approach to reducing obesity. Obesity Reviews (2008)
  • Potential policy interventions to improve dietary intake for preventing obesity in Malaysia Policy areas Food distribution & retail 1. 2. 3. 4. 5. 6. 7. 8. Potential policy interventions Limiting the sales of high fat & high sugar food/ beverages in schools & learning institutions (canteen, cafeteria & co-operative shop). Control of vending machines in schools, higher education institutes and public buildings. Control the licensing for food vendors within close proximity (e.g. <500m) from schools. Density controls over new fast food outlets, in all areas, both urban and rural. Restrict retail hours of fast food outlets, restaurants and hawker stalls (e.g. to be closed at 10 pm.) Compulsory inclusion of healthy choices (e.g. drinking water, low sugar/fat/ salt snacks) in vending machines. Restricting the sale of energy-dense and nutrient-poor foods in workplace canteens. Compulsory to have a fruit/salad stall at any food outlet in public institutions (e.g. schools, universities, offices, hospitals). 24 This policy-mapping analysis grid is adapted from G. Sacks, B. Swinburn & M. Lawrence: Obesity Policy Action framework and analysis grids for a comprehensive policy approach to reducing obesity. Obesity Reviews (2008)
  • Potential policy interventions to improve dietary intake for preventing obesity in Malaysia Policy areas Food service 1. 2. 3. Potential policy interventions Implementation of healthy food service policies in public institutions (e.g. schools, universities, government departments, hospitals). Mandatory for cafeteria operators and caterers to be trained and accredited on healthy food provisions and preparations. Compulsory for every food service to include fruits and vegetables in every set meal . 25 This policy-mapping analysis grid is adapted from G. Sacks, B. Swinburn & M. Lawrence: Obesity Policy Action framework and analysis grids for a comprehensive policy approach to reducing obesity. Obesity Reviews (2008)
  • National Diabetes Registry • Web-based application. • Went live on 1 January 2011. • Supports the implementation of the annual “Diabetes Clinical Audit” and the “Diabetes Quality Assurance Programme” amongst Type 2 Diabetes patients in MOH Health Clinics. • First report, “NDR Report, Volume 1, 20092012” was published in August 2013, available at the MOH website, under “publications”. 26
  • Summary • We know what needs to be done for the prevention and control of NCD. • What we do not know is how best to implement in real life situations and within the socio-cultural context of Malaysia. • Implementation-type research, including behavioural (qualitative research) can provide evidence in answering this question. • Multisectoral approach, not only in implementation but in research as well. 27
  • Thank you dr.feisul@moh.gov.my Facebook: Feisul Mustapha 28