National NCD Program in Oman

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  • The Pacific Islands and MENA dominate this category. The rates are more than twice the global average. Changes again only take into account changes in the population structure and urbanisation. For Pacific Islands, urbanisation is 100% so it is just age changes that can be expected. New for this edition: IMPORTANT: Nauru is no longer number 1 This is due not only to new data from the region, but may also reflect the effects of mortality due to diabetes. The emergence of MENA – 6 out of the 10 countries are in MENA
  • National NCD Program in Oman

    1. 1. National NCD Program in Oman Dr. Ali Jaffer Mohammed Advisor Health Affairs MOH1 Ministry of Health Oman
    2. 2. Presentation Overview• Five Year Plans• NCD’s Burden in Oman• Diabetes as an example• Program Implementation -National Level -District Hospital level -PHC level -Community Level2 Ministry of Health Oman
    3. 3. The Five year Plans3 7th Five Year Plan 2006-2010 8th Five year plan 2011-2015 Ministry of Health Oman
    4. 4. Five Year Plan -Domain 13:NCD’s 7th Five Year Plan 2006-2010 8th Five year plan 2011-20154 Ministry of Health Oman
    5. 5. Scope & Rational• High Prevalence of NCDs in Oman (Ages 20+ years): Behavioral/individual Risk factors• Diabetes 12%• Hypertension 35%• Dyslipidaemia 40%• Overweight & obesity 48%• Tobacco use 23% 14.7%Source: OWHS-2008 (2008) (2011)5 Ministry of Health Oman
    6. 6. Insulin Resistance Syndrome (Metabolic Syndrome) Central/abdominal obesity 24.6%High TG 20.7% MicroalbuminuriaLow HDL 75.4% Prevalence of metabolic syndrome HBP 23.1% Oman 21% Endothelial USA dysfunctionHigh FPG 18.1% 23% Atherosclerosis, cardiovascular disease6 Source: Nizwa 2001 Ministry of Health Oman
    7. 7. Deaths attributable to diseases and injuries, all ages,Oman, 2002. Total Deaths attributable to NCDs =62% 7 Ministry of Health Source :WHO Global Burden of Disease 2002. Oman
    8. 8. Disability-adjusted life years lost attributable to diseases and injuries, all ages, Oman, 2002. Total DALYs lost attributable to NCDs=23%8 Ministry of Health Source: WHO Global Burden of Disease 2002 Oman
    9. 9. RationalIn the WHO Global Action Plan for Prevention and Control of NCD objective # 3 is To promote interventions to reduce the main shared modifiable risk factors for non-communicable diseases : tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol.So the Oman NCD prevention and control program is carrying out the activities at different health care levels9 Ministry of Health Oman
    10. 10. The Top 10s (prevalence %) Till 2010 Oman was ranked in top 10, but in 2011 when the International Diabetes Federation(IDF) recalculated the prevalence using different criteria, it has become 43rd Rank with a 10.75% prevalence 8th ( 43rd 43. Oman 10.75 IDF Atlas, V5, 201110 Ministry of Health Oman
    11. 11. Country/territory Comp. prevalence (%) WHO Standard Kuwait 21.10 6th Lebanon 20.17 Qatar 20.17 Saudi Arabia 20.02 Bahrain 19.88 UAE 19.22 To Egypt 16.94 Libyan 14.19 Jordan 12.37 Iran 11.34 Oman 10.75 11th11 IDF Atlas, V5, 2011 Ministry of Health Oman
    12. 12. Annual and Cummulative Number of People with Diabetes on the Register 70000 New registered diabetic Total registered diabetic 61583 60000 57167 56036 =11.50% 54599 50000 48972 42017 40000No. of Cases 37286 30000 31704 >40 years 27432 population= 23386 20000 535344 (2011 data ) 10000 4862 5167 5482 5393 5413 3590 3487 3548 4177 4372 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Annual Health Reports 2000-2009 Year 12 Ministry of Health Oman
    13. 13. 40-59 Years Old Most Affected 1800 1600 1400 1200 20-29 No. of Cases 1000 30-39 800 40-49 600 400 50-59 200 60-69 0 70+ 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009Annual Health Reports 2000-2009 Year 13 Ministry of Health Oman
    14. 14. Action by in MOH• High Political Commitment• Established NCD Department 2003 – Priority Diseases section (DM, CVD, Cancer, Renal) – Specific Diseases (eye, ear) – Mental Health – Tobacco Control• Formation of National Diabetes Committee14 Ministry of Health Oman
    15. 15. Surveillance of NCDs• Oman-pioneered applying the WHO protocol for the Diabetes Survey in 1991,• Then Surveys were carried out 10 yearly- in 2000, and 2008(as part of Oman WHS• National Diabetes Register15 Ministry of Health Oman
    16. 16. •Risk Factors(enter the number) Baseline •Weight( Kg ) First Year • Height (cm) • Duration of Diabetes •Clinical findings - Blood Pressure Peripheral Pulses Neuropathy Fundus Retinopathy Foot Ulcer Five years •Laboratory Investigations -Blood Glucose-(Fasting &2 hrs pp) -OGTT –(fasting & 2 hr pp) -Fasting Lipids-(cholesterol, LDL, HDL,TG) -Renal Function ( Blood urea, creatinine, Urine-protein, sugar, ketones) -HbAIC -ECG •Type of Diabetes •Treatment • Remarks Twelve years 16 Ministry of Health16 Oman
    17. 17. Actions: At District Hospital – Distinct clinic for diabetes • Specialist physician • Nurse • “Educator” •Insulin •Oral hypoglycemics – Medication for Rx of DM- •Antihypertensives •Statins are available at all – Glycated HbA1c Care levels. The Higher PHC Committee and Diabetes Committee will approve new medicines as per17 requirement Ministry of Health Oman
    18. 18. Diabetic clinics in Poly Clinics 20 18 16Clinics 14 12 diabetic clinics in PC Target by 2010 10 8 2005 2006 2007 2008 2009Department of NCD, MOH, Oman Year 18 Ministry of Health Oman
    19. 19. Combined Clinics 25 DM & Obgyn 20 Target 15 Clinics 10 5 0 2005 2006 2007 2008 2009Department of NCD, MOH, Oman Year 19 Ministry of Health Oman
    20. 20. At PHC level Increase in Mini-Diabetes Clinic 120 100 100 88 90 80 60 61 50 50 50 50 50 40 30 20 Mini Diab & HTN Clinics Target 0 2005 2006 2007 2008 2009Department of NCD, MOH, Oman 20 Ministry of Health Oman
    21. 21. … At PHC • Training of GPs and Nurses21 Ministry of Health Oman
    22. 22. 22 Ministry of Health Oman
    23. 23. Diabetic Foot Training Omanis on Podiatry (Outside Oman) + (in Oman) • In 2008 , 5 Omanis were sent to Australia for doing their BSc IN Podiatry at La Trobe University • They then carried out Training for Nurses in Podiatry in Oman.23 Ministry of Health Oman
    24. 24. Training for Nurses in Podiatry carried out by Glasgow Caledonia University24 Ministry of Health Oman
    25. 25. Nurse-Run in Foot Clinics 25 Diabetic Foot Clinics 23 20 No. of Clinics 15 15 10 5 1 1 1 0 2005 2006 2007 2008 2009Department of NCD, MOH, Oman Year 25 Ministry of Health Oman
    26. 26. 1 Oman Sea UAE 5Distribution of 1 3 2Diabetes Foot 1 4 2 3 Clinics Kingdom of Saudi Arabia (April 2009) 0 1 Yemen Arabian Sea26 Ministry of Health Oman
    27. 27. Reduction in Amputation Amputations/10,000 Patients/yr 50 Foot amputation 45 40 35 30 25 20 15 10 5 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 YearDepartment of NCD, MOH, Oman 27 Ministry of Health Oman
    28. 28. Secondary Prevention SCREENING TOOLS28 Ministry of Health Oman
    29. 29. Non-Invasive Tool Diabetes Risk Score(Has Not been implemented in Oman as Screening for Common NCDs for >40 years old is implemented 29 Ministry of Health Oman
    30. 30. 2.4.1 The National NCD Screening Program 200630 Ministry of Health Oman
    31. 31. 31 Ministry of Health Oman
    32. 32. In PHC • Screening for common NCD conditions: (only for 40+ years) – Diabetes (FBS) – Hypertension (BP measurement) – Chronic Renal disease (GFR) – Dyslipidaemia (TC, HDL, LDL, TG) – Obesity (BMI, WC)32 Ministry of Health Oman
    33. 33. NCD Screening Results (2008) Males Females Both No. Screened 6,785 10,894 17,679 (38%) (62%)BMI>30 23% 36% 31%Abnormal 54% 76% 68%WCPre-HTN 15% 14% 14%HTN 21% 19% 19%Pre-DM 36% 35% 35%DM 8% 6% 7%High Choles. 43% 47% 46%eGFR < 90 33 32% 26% 28% Ministry of Health Oman
    34. 34. At Community Level34 Ministry of Health Oman
    35. 35. Community Based Initiatives• The Nizwa Healthy Lifestyle project – WHO Community Based Program supported by MOH. -1st baseline risk factor survey. - In 2010 Evaluation of project was done by WHO Consultant. -It has been extended to other areas like Sur etc.• School Health Program -The Health Promoting Schools program -Facts of Life 35 Ministry of Health Oman
    36. 36. Tobacco Control Oman• Oman Ratified FCTC 2005• Smoking ban in all public places• Pictorial Health Warning ( all GCC)• Maintaining the status quo is a big challenge -due to tobacco lobbyists -Increased Shisha useage in older age group in both men and women36 Ministry of Health Oman
    37. 37. Challenges (1) • PHC structure needs further changes • Inadequate number trained staff to deal with complex NCD conditions • Unavailability of latest medications (e.g.insulin Analogue) due to cost constraints • Limited lab services for tests in PHC –No electronic linkages for test results from Hospitals37 Ministry of Health Oman
    38. 38. Challenges (2) • Need for electronic record system for defaulters follow-up, monitoring & evaluation • Shortage of health educators38 Ministry of Health Oman
    39. 39. Thank You39 Ministry of Health Oman

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