This document provides an overview of obesity and its prevalence in Malaysia. It discusses the major non-communicable diseases (NCDs) like heart disease, diabetes, cancers and chronic lung disease, and their common modifiable risk factors like tobacco use, unhealthy diets, physical inactivity and alcohol use. It summarizes data from national health surveys showing increasing trends in obesity, diabetes, hypertension and hypercholesterolemia in Malaysia over time. It also discusses Malaysia's national strategic plan for NCD prevention and control from 2010-2014 and commitments under the WHO Global Action Plan to reduce NCDs.
Health in Malaysia - obesity and diabetes - June 2020 / マレーシアの健康事情(肥満と糖尿病 )栄治 村社
今回は、マレーシアの健康事情として肥満と糖尿病についてまとめてみた。以前から、マレーシアの肥満と糖尿病は国内で大きな問題とされており、政府も啓もう活動を展開しているが、年々深刻な状況になっている。
世界銀行の報告によると、2019年におけるマレーシアの糖尿病有病率は16.7%であり、これはアジアで最も高い数字となっている。また、世界保健機構の報告書によると、2016年の死亡原因において糖尿病が全体の3%を占めており、無視できない状況とされている。その背景には、国民の37.3%が太りすぎ、12.9%は肥満、そして半数が運動不足という現実がある。
子供たちはさらに深刻な状況に置かれており、マレーシア保健省は2025年までに165万人の子供が太りすぎ・肥満になると予想しており、糖尿病や高血圧、脂肪肝といった疾患が懸念されている。成人においても、現状が続けば2025年までには3人に1人が糖尿病患者になると予想している。
これら背景には、糖分やカロリーの高い食品や飲料を好む傾向にあること、運動をほとんどしない国民性などを挙げることができる。自動車社会であることから通勤・通学でもあまり歩かないし、最近はスマートフォン中心の生活環境がさらに拍車をかけているように感じる。実際の統計資料においても、一人当たりの砂糖消費量は58.2kgで日本の約3.5倍にもなるし、週当たりの運動時間は1~2時間が最も多く、全く運動しない人も10%近くになる。
さらに、糖尿病患者の増加は国の医療負担を増しており、2011年には医療予算の13%を占める20億リンギットが使われている。そのため、政府は2019年7月1日に砂糖税を導入し、非伝染性疾患の社会的有病率を減少を目指しているし、NCD Prevention and Control Program in Malaysia(2016-2025)では2025年までの非感染性疾患の目標値が示されている。こうした措置や政策により、飲料メーカー各社は低糖・無糖をアピールした商品の販売を開始しており、コカ・コーラにおいては2019年第3四半期でCoca-Cola Zeroが2桁成長を記録し、同社の増益に大きく寄与している。実際ハイパーマーケットのマネージャーに聞いた話では、無糖のお茶など飲料は普通に売れているし、最近は健康志向から乳酸菌飲料に対する人気が高いとしていた。
とは言え、マレーシアにおいて肥満と糖尿病は当面は国民が抱える問題として台頭を続けると思われる。ただ、中間層以上は食生活に対して注意を払う傾向になっているし、15年前と比較するとランニングやサイクリングを楽しむ国民は増えており、フィットネスジムの数も確実に伸びてきていると感じる。
Managment of Diabesity (Obesity in diabetes mellitus) Tarek Al 3reeny
This presentation summaries state of the art management of obesity in diabetes mellitus (diabesity) including definition and classifications of both obesity and diabetes. Multidisciplinary approach , pharmacotherapy & bariatric surgery
Diabetes mellitus is a major global public health problem. The rise in global prevalence is expected to reach 5.4% or 300 million worldwide by 2025, with developed countries carrying a larger burden (1). Malaysia is not spared from this phenomena, with an alarming rise in prevalence of Type 2 diabetes mellitus (T2DM) over the past fifteen years, from 8.3% (NHMS 1, 1996) to 20.8% (NHMS IV, 2011) (2). What is most worrying is the figure for undiagnosed diabetics, which recorded almost a ten-fold increase (from 1.8% to 10.1%) within the same period. The national economic burden for provision of ambulatory or outpatient care for diabetes patients alone was estimated to cost the Ministry of Health RM 836 million, which took up 2.2% of the nation’s total health expenditure for 2009 (3). The average provider cost per outpatient visit for diabetes treatment at primary care was RM393.24, compared to RM 2707.44 at Specialist diabetic clinics. Treatment at primary care health centres was also highly cost effective compared to Specialist diabetic clinics (4). Due to the chronic nature of the disease, its many related complications and the progress in medical expertise, the costs to provide health care for the this group can only be expected to escalate in years to come. Strategies to effectively treat the chronic diseases (i.e. NCDs and T2DM) have been in place since the 1990s, however, the National Strategic Planning for Non-Communicable Diseases, (NSPNCD)(5) recommends that efforts should be channeled towards primary prevention, early NCD risk factor identification and NCD risk factor intervention or “clinical preventive services”. The clinical preventive services however, need to be emphasised, as early preventive measures can reduce long-term complications and morbidity related to diabetes. The risk factors which should trigger clinicians to provide clinical preventive measures include: obesity, sedentary lifestyles, dietary indiscretions, elderly (for late onset diabetes, pancreas insufficiency), family history of diabetes (risk in offspring of one diabetic parent: 30%, both parents: 60%). The 10th Malaysian Plan : Country Health Plan aims to restructure the national healthcare financing and healthcare delivery system to ensure universal health coverage of healthcare services to be provided at minimal cost using the existing infrastructure in delivering continuity of care across programmes, across healthcare settings and across healthcare providers (6). To reduce the fragmentation of care which commonly occurs in most NCD programmes, there is a need to involve healthcare providers within the healthcare service to be orientated in their roles and contribution in providing a seamless long-term care programme. It is hoped that this effort will benefit not only the patients but also provide relevant feedback on quality of healthcare service provision by the stakeholders. The current public health centre set up which combines Outpatient Primary Care
Health in Malaysia - obesity and diabetes - June 2020 / マレーシアの健康事情(肥満と糖尿病 )栄治 村社
今回は、マレーシアの健康事情として肥満と糖尿病についてまとめてみた。以前から、マレーシアの肥満と糖尿病は国内で大きな問題とされており、政府も啓もう活動を展開しているが、年々深刻な状況になっている。
世界銀行の報告によると、2019年におけるマレーシアの糖尿病有病率は16.7%であり、これはアジアで最も高い数字となっている。また、世界保健機構の報告書によると、2016年の死亡原因において糖尿病が全体の3%を占めており、無視できない状況とされている。その背景には、国民の37.3%が太りすぎ、12.9%は肥満、そして半数が運動不足という現実がある。
子供たちはさらに深刻な状況に置かれており、マレーシア保健省は2025年までに165万人の子供が太りすぎ・肥満になると予想しており、糖尿病や高血圧、脂肪肝といった疾患が懸念されている。成人においても、現状が続けば2025年までには3人に1人が糖尿病患者になると予想している。
これら背景には、糖分やカロリーの高い食品や飲料を好む傾向にあること、運動をほとんどしない国民性などを挙げることができる。自動車社会であることから通勤・通学でもあまり歩かないし、最近はスマートフォン中心の生活環境がさらに拍車をかけているように感じる。実際の統計資料においても、一人当たりの砂糖消費量は58.2kgで日本の約3.5倍にもなるし、週当たりの運動時間は1~2時間が最も多く、全く運動しない人も10%近くになる。
さらに、糖尿病患者の増加は国の医療負担を増しており、2011年には医療予算の13%を占める20億リンギットが使われている。そのため、政府は2019年7月1日に砂糖税を導入し、非伝染性疾患の社会的有病率を減少を目指しているし、NCD Prevention and Control Program in Malaysia(2016-2025)では2025年までの非感染性疾患の目標値が示されている。こうした措置や政策により、飲料メーカー各社は低糖・無糖をアピールした商品の販売を開始しており、コカ・コーラにおいては2019年第3四半期でCoca-Cola Zeroが2桁成長を記録し、同社の増益に大きく寄与している。実際ハイパーマーケットのマネージャーに聞いた話では、無糖のお茶など飲料は普通に売れているし、最近は健康志向から乳酸菌飲料に対する人気が高いとしていた。
とは言え、マレーシアにおいて肥満と糖尿病は当面は国民が抱える問題として台頭を続けると思われる。ただ、中間層以上は食生活に対して注意を払う傾向になっているし、15年前と比較するとランニングやサイクリングを楽しむ国民は増えており、フィットネスジムの数も確実に伸びてきていると感じる。
Managment of Diabesity (Obesity in diabetes mellitus) Tarek Al 3reeny
This presentation summaries state of the art management of obesity in diabetes mellitus (diabesity) including definition and classifications of both obesity and diabetes. Multidisciplinary approach , pharmacotherapy & bariatric surgery
Diabetes mellitus is a major global public health problem. The rise in global prevalence is expected to reach 5.4% or 300 million worldwide by 2025, with developed countries carrying a larger burden (1). Malaysia is not spared from this phenomena, with an alarming rise in prevalence of Type 2 diabetes mellitus (T2DM) over the past fifteen years, from 8.3% (NHMS 1, 1996) to 20.8% (NHMS IV, 2011) (2). What is most worrying is the figure for undiagnosed diabetics, which recorded almost a ten-fold increase (from 1.8% to 10.1%) within the same period. The national economic burden for provision of ambulatory or outpatient care for diabetes patients alone was estimated to cost the Ministry of Health RM 836 million, which took up 2.2% of the nation’s total health expenditure for 2009 (3). The average provider cost per outpatient visit for diabetes treatment at primary care was RM393.24, compared to RM 2707.44 at Specialist diabetic clinics. Treatment at primary care health centres was also highly cost effective compared to Specialist diabetic clinics (4). Due to the chronic nature of the disease, its many related complications and the progress in medical expertise, the costs to provide health care for the this group can only be expected to escalate in years to come. Strategies to effectively treat the chronic diseases (i.e. NCDs and T2DM) have been in place since the 1990s, however, the National Strategic Planning for Non-Communicable Diseases, (NSPNCD)(5) recommends that efforts should be channeled towards primary prevention, early NCD risk factor identification and NCD risk factor intervention or “clinical preventive services”. The clinical preventive services however, need to be emphasised, as early preventive measures can reduce long-term complications and morbidity related to diabetes. The risk factors which should trigger clinicians to provide clinical preventive measures include: obesity, sedentary lifestyles, dietary indiscretions, elderly (for late onset diabetes, pancreas insufficiency), family history of diabetes (risk in offspring of one diabetic parent: 30%, both parents: 60%). The 10th Malaysian Plan : Country Health Plan aims to restructure the national healthcare financing and healthcare delivery system to ensure universal health coverage of healthcare services to be provided at minimal cost using the existing infrastructure in delivering continuity of care across programmes, across healthcare settings and across healthcare providers (6). To reduce the fragmentation of care which commonly occurs in most NCD programmes, there is a need to involve healthcare providers within the healthcare service to be orientated in their roles and contribution in providing a seamless long-term care programme. It is hoped that this effort will benefit not only the patients but also provide relevant feedback on quality of healthcare service provision by the stakeholders. The current public health centre set up which combines Outpatient Primary Care
A presentation on the care of diabetes in elderly people. This presentation is chiefly based on ADA guideline 2015 and focuses on the management of diabetes in persons aged >65 years.
Prediabetes means that your blood sugar level is higher than normal but not yet high enough to be classified as type 2 diabetes. Without intervention, prediabetes is likely to become type 2 diabetes in 10 years or less.
this is a brief study on prediabetes , in present scenario many of them are prediabetic ......
please comment
thank you
This presentation deals with the various approaches of medical nutrition therapy in Diabetes, comparison of the ADA, RSSDI and ICMR guidelines. It also talks about the various calorie counting apps as well.
Table of Contents
1. Meaning, Definitions, Concepts and Causes of Obesity
2. Eating Disorders and Health Risks Associated with Obesity
3. Assessment of Obesity
Dr Kate Allen: Obesity, Physical Activity and Cancer: Implications for Policy Irish Cancer Society
Dr Kate Allen, Executive Director (Science and Public Affairs) of World Cancer Research Fund International, UK, spoke about the relationship of obesity and physical Activity on cancer, and consequential implications for policy.
A presentation on the care of diabetes in elderly people. This presentation is chiefly based on ADA guideline 2015 and focuses on the management of diabetes in persons aged >65 years.
Prediabetes means that your blood sugar level is higher than normal but not yet high enough to be classified as type 2 diabetes. Without intervention, prediabetes is likely to become type 2 diabetes in 10 years or less.
this is a brief study on prediabetes , in present scenario many of them are prediabetic ......
please comment
thank you
This presentation deals with the various approaches of medical nutrition therapy in Diabetes, comparison of the ADA, RSSDI and ICMR guidelines. It also talks about the various calorie counting apps as well.
Table of Contents
1. Meaning, Definitions, Concepts and Causes of Obesity
2. Eating Disorders and Health Risks Associated with Obesity
3. Assessment of Obesity
Dr Kate Allen: Obesity, Physical Activity and Cancer: Implications for Policy Irish Cancer Society
Dr Kate Allen, Executive Director (Science and Public Affairs) of World Cancer Research Fund International, UK, spoke about the relationship of obesity and physical Activity on cancer, and consequential implications for policy.
As part of the IFPRI Egypt Seminar in partnership with the National Nutrition Committee (ASRT affiliated): "100 million healthy lives: Scientific evidence on the double burden of malnutrition in Egypt"
Strengthening ncd surveillance in malaysia, asean ncd forum 2013Feisul Mustapha
Zainal Ariffin Omar and Feisul Idzwan Mustapha. Strengthening NCD Surveillance in Malaysia. 15 September 2013. Working paper presented at the ASEAN Regional Forum on NCDs. Manila, Philippines.
A non-communicable disease (NCD) is a medical condition or disease that is not caused by infectious agents (non-infectious or non-transmissible). NCDs can refer to chronic diseases which last for long periods of time and progress slowly. Sometimes, NCDs result in rapid deaths such as seen in certain diseases such as autoimmune diseases, heart diseases, stroke, cancers, diabetes, chronic kidney disease, osteoporosis, Alzheimer's disease, cataracts, and others. While sometimes referred to as synonymous with "chronic diseases", NCDs are distinguished only by their non-infectious cause, not necessarily by their duration, though some chronic diseases of long duration may be caused by infections. Chronic diseases require chronic care management, as do all diseases that are slow to develop and of long duration.
NCDs are the leading cause of death globally. In 2012, they caused 68% of all deaths (38 million) up from 60% in 2000. About half were under age 70 and half were women.Risk factors such as a person's background, lifestyle and environment increase the likelihood of certain NCDs. Every year, at least 5 million people die because of tobacco use and about 2.8 million die from being overweight. High cholesterol accounts for roughly 2.6 million deaths and 7.5 million die because of high blood pressure.
Non-Communicable Diseases: Malaysia in Global Public HealthFeisul Mustapha
Paper presented at a CME Session, held in conjunction with the NIH Research Week 2014, 26 November 2014 at the Institute for Health Management, Bangsar
Pius Tih Muffih, PhD, MPH, Director, Cameroon Baptist Convention Health Services discusses the organization's Know Your Numbers program, which is a partnership with the local government to screen adults for hypertension and obesity at the 2018 CCIH conference.
Management of diabetes in malaysia, istanbul 2013[final]Feisul Mustapha
Management of Diabetes in Malaysia. Plenary paper presented by Dato' Sri Dr Hilmi Yahaya, Deputy Minister of Health Malaysia at the International Diabetes Leadership Forum. 15 November 2013. Istanbul, Turkey. Paper was prepared by Dr Zainal Ariffin Omar and myself
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
Overview of obesity in Malaysia
1. Overview on Obesity, Aetiology
and Epidemic in Malaysia:
How serious is the problem?
Feisul Idzwan Mustapha MBBS, MPH, AM(M)
NCD Section, Disease Control Division
Ministry of Health, Malaysia
Clinical Dietetic Update in Weight Management
11 August 2014
Putrajaya
dr.feisul@moh.gov.my
Ministry of Health
Malaysia
2. There are Four MajorGroupsof Non-
CommunicableDiseases;
Four majorlifestyles related riskfactors
Modifiable causative risk factors
Tobacco use
Unhealthy
diets
Physical
inactivity
Harmful
use of
alcohol
Noncommunicablediseases
Heart disease
and stroke
Diabetes
Cancers
Chronic lung
disease
2
3. 8.3
14.9
20.8
6.5
9.5
10.7
1.8
5.4
10.1
4.3 4.7 5.3
0
5
10
15
20
25
NHMS II (1996) NHMS III
(2006)
NHMS 2011
Prevalence(%)
Prevalence of Diabetes,
≥30 years (1996, 2006 & 2011)
Total diabetes
Known
Undiagnosed
IFG
Source: National Health & Morbidity Surveys (NHMS)
32.2 32.7
12.8
19.8
0
5
10
15
20
25
30
35
NHMS III (2006) NHMS 2011
Prevalence(%)
Prevalence of Hypertension,
≥18 years (2006 & 2011)
Total HPT
Known
Undiagnosed
20.6
35.1
8.4
26.6
0
5
10
15
20
25
30
35
40
NHMS III (2006) NHMS 2011
Prevalence(%)
Prevalence of Hypercholesterolaemia,
≥18 years (2006 & 2011)
Total HChol
Known
Undiagnosed
3
7. Sub-analysis of NHMS 2011 data
• At least 15% (18 years and above) already with known NCD
risk factors (diabetes, hypertension or hypercholesterolemia).
• Undiagnosed high blood sugar, high blood pressure or high
cholesterol: 42.1% (18 years and above).
• Alternatively, if include obesity: 48.3% (18 years and above).
• Therefore our high risk and at risk population: 63.3% (18
years and above)
7
8. Sub-analysis of NHMS 2011 data
Prevalence CI Lower CI Upper
Est.
population
Diabetes (known) 7.2 1,247,366
Diabetes (known) only, without
hypertension (total) or without
hypercholesterolaemia (total) 1.22 1.04 1.43 209,532
Diabetes (known) and
hypertension (total) 5.18 4.78 5.61 893,578
Diabetes (known) and
hypertension (total) +
hypercholesterolaemia (total) 3.31 3.00 3.64 567,494
8
9. Sub-analysis of NHMS 2011 data
Prevalence
CI
Lower
CI
Upper
Est.
population
Hypertension (known) 12.8 2,271,995
Hypertension (known) only,
without diabetes (total) or
without hypercholesterolaemia
(total) 3.47 3.16 3.81 596,157
Hypertension (known) and
hypercholesterolaemia (total) 7.62 7.10 8.17 1,338,920
Hypercholesterolaemia (known) 8.4 1,478,453
Hypercholesterolaemia only,
without hypertension (total) or
without diabetes (total) 2.25 1.95 2.59 386,473
9
10. Sub-analysis of NHMS 2011 data
Prevalence CI Lower CI Upper
Est.
population
Obesity 15.1 2,462,152
Obesity only, without diabetes
(total) or without hypertension
(total) or without
hypercholesterolaemia (total) 3.72 3.35 4.12 587,966
10
11. Sub-analysis of NHMS 2011 data
WHO/ISH CVD 10-year risk
prediction: Risk Levels among those
with UNDIAGNOSED DIABETES OR
UNDIAGNOSED HYPERTENSION OR
UNDIAGNOSED
HYPERCHOLESTEROLAEMIA Prevalence CI Lower CI Upper
Est.
population
<10% 85.58 84.53 86.57 6,250,178
10% to <20% 7.42 6.73 8.16 541,584
20% to <30% 2.98 2.55 3.48 217,693
30% to <40% 1.71 1.42 2.06 125,124
40% and above 2.31 1.92 2.76 168,440 11
12. 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.
12
13. Recent UN/WHO Mandates
• High-level meeting of the General Assembly on the
comprehensive review and assessment of the progress
achieved in the prevention and control of NCDs (10-11 July
2014)
• Global Action Plan for the Prevention and Control of NCDs
2013-2020
13
14. High-level meeting of the General
Assembly on the comprehensive
review and assessment of the
progress achieved in the prevention
and control of NCDs
• Specific commitments on (among others):
• Leadership & governance
• Prevention & risk factor exposure
• Health systems
• Monitoring and evaluation
14
15. Global Action Plan for the
Prevention and Control of NCDs
2013-2020
• Six (6) objectives
• Nine (9) voluntary global targets
• Appendix 3: Menu of policy options and cost effective
interventions
15
16. 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)
16
17. Cost effective interventions to
address NCDs
17
Population-
based
interventions
addressing
NCD
risk factors
Tobacco use - 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
- 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
Individual-
based
interventions
addressing
NCDs in
primary care
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
18. Objective 3 GAP NCD 2013-2020:
Healthy Diet
• Three (3) relevant global targets:
• A 30% relative reduction in mean population intake of
salt/sodium
• A halt in the rise in diabetes and obesity
• A 25% relative reduction in the prevalence of raised blood
pressure or containment of the prevalence of raised blood
pressure according to national circumstances.
18
19. Objective 3 GAP NCD 2013-2020:
Healthy Diet
• Promote and support exclusive breastfeeding for the first
six months of life, continued breastfeeding until two
years old and beyond and adequate and timely
complementary feeding.
• Implement WHO’s set of recommendations on the
marketing of foods and non-alcoholic beverages to
children, including mechanisms for monitoring.
19
20. Objective 3 GAP NCD 2013-2020:
Healthy Diet
• Develop guidelines, recommendations or policy measures that
engage different relevant sectors, such as food producers and
processors, and other relevant commercial operators, as well as
consumers, to:
• Reduce the level of salt/sodium added to food (prepared or
processed).
• Increase availability, affordability and consumption of fruit and
vegetables.
• Reduce saturated fatty acids in food and replace them with
unsaturated fatty acids.
• Replace trans-fats with unsaturated fats.
• Reduce the content of free and added sugars in food and non-
alcoholic beverages.
• Limit excess calorie intake, reduce portion size and energy density of
foods. 20
21. Objective 3 GAP NCD 2013-2020:
Healthy Diet
• Develop policy measures that engage food retailers and
caterers to improve the availability, affordability and
acceptability of healthier food products (plant foods,
including fruit and vegetables, and products with
reduced content of salt/sodium, saturated fatty acids,
trans-fatty acids and free sugars).
• Promote the provision and availability of healthy food in
all public institutions including schools, other educational
institutions and the workplace. (e.g. through nutrition standards
for public sector catering establishments and use of government contracts
for food purchasing)
21
22. Objective 3 GAP NCD 2013-2020:
Healthy Diet
• As appropriate to national context, consider economic
tools that are justified by evidence, and may include
taxes and subsidies, that create incentives for behaviours
associated with improved health outcomes, improve the
affordability and encourage consumption of healthier
food products and discourage the consumption of less
healthy options.
• Develop policy measures in cooperation with the
agricultural sector to reinforce the measures directed at
food processors, retailers, caterers and public
institutions, and provide greater opportunities for
utilization of healthy agricultural products and foods. 22
23. Objective 3 GAP NCD 2013-2020:
Healthy Diet
• Conduct evidence-informed public campaigns and social
marketing initiatives to inform and encourage consumers
about healthy dietary practices. Campaigns should be linked
to supporting actions across the community and within
specific settings for maximum benefit and impact.
• Create health- and nutrition-promoting environments,
including through nutrition education, in schools, child care
centres and other educational institutions, workplaces, clinics
and hospitals, and other public and private institutions.
• Promote nutrition labelling, according to but not limited to,
international standards, in particular the Codex Alimentarius,
for all pre-packaged foods including those for which nutrition
or health claims are made.
23
24. Objective 3 GAP NCD 2013-2020:
Promoting Physical Activity
• Three (3) relevant global targets:
• A 10% relative reduction in prevalence of insufficient physical
activity.
• Halt the rise in diabetes and obesity.
• A 25% relative reduction in the prevalence of raised blood
pressure or contain the prevalence of raised blood pressure
according to national circumstances.
24
25. Objective 3 GAP NCD 2013-2020:
Promoting Physical Activity
• Adopt and implement national guidelines on physical
activity for health.
• Consider establishing a multi-sectoral committee or
similar body to provide strategic leadership and
coordination.
• Develop appropriate partnerships and engage all
stakeholders, across government, NGOs and civil society
and economic operators, in actively and appropriately
implementing actions aimed at increasing physical
activity across all ages.
25
26. Objective 3 GAP NCD 2013-2020:
Promoting Physical Activity
• Develop policy measures in cooperation with relevant sectors to
promote physical activity through activities of daily living, including
through “active transport,” recreation, leisure and sport, for example:
• National and sub-national urban planning and transport policies to
improve the accessibility, acceptability and safety of, and supportive
infrastructure for, walking and cycling.
• Improved provision of quality physical education in educational settings
(from infant years to tertiary level) including opportunities for physical
activity before, during and after the formal school day.
• Actions to support and encourage “physical activity for all” initiatives for
all ages.
• Creation and preservation of built and natural environments which
support physical activity in schools, universities, workplaces, clinics and
hospitals, and in the wider community, with a particular focus on
providing infrastructure to support active transport i.e. walking and
cycling, active recreation and play, and participation in sports.
• Promotion of community involvement in implementing local actions
aimed at increasing physical activity.
26
27. Objective 3 GAP NCD 2013-2020:
Promoting Physical Activity
• Conduct evidence-informed public campaigns through
mass media, social media and at the community level
and social marketing initiatives to inform and motivate
adults and young people about the benefits of physical
activity and to facilitate healthy behaviours. Campaigns
should be linked to supporting actions across the
community and within specific settings for maximum
benefit and impact.
• Encourage the evaluation of actions aimed at increasing
physical activity, to contribute to the development of an
evidence base of effective and cost-effective actions.
27
28. National Strategic Plan for
Non-Communicable Diseases
(NSP-NCD) 2010-2014
• 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”
Seven Strategies:
1. Prevention and Promotion
2. Clinical Management
3. Increasing Patient
Compliance
4. Action with NGOs,
Professional Bodies & Other
Stakeholders
5. Monitoring, Research and
Surveillance
6. Capacity Building
7. Policy and Regulatory
interventions
28
29. Current Approaches to NCD From Birth To Tomb
Intervention
Package
Health
Promotion
Pregnancy
Pre-
conception
Infant/
Toddler
First 1,000 Days
To reduce obesity and NCDs-birth weight
Lifestyle during pregnancy – fetal health
Pre-
School
School-
going Age
Garispanduan Pemasaran Makanan
& Minuman kepada Kanak-kanak
Garispanduan Penguatkuasaan
Larangan Penjualan Makanan &
Minuman Di Luar Pagar Sekolah
Higher
Education
Adults Elderly
School Setting
Workplace / Community
Setting
KOSPEN
AktivitiFizikal
Program Warga Aktif
Warga Produktif
Healthy Workplace
for Healthy
Workforce
Garispanduan
Pengurusan Kantin
Sihat
Garispanduan Perlaksanaan
Vending Machine Makanan &
Minuman Sihat dlm
Perkhidmatan Awam
Kafeteria Sihat
Hidangan Sihat
Semasa Mesyuarat
Amalan
Pemakanan Sihat
Jom Mama
Initiatives
29
30. Multi-disciplinary care
team (in health clinics)
Post-basic training
for paramedics
Clinical practice
guidelines
Quality improvement
programs
Clinical
information
systems
Patient resource
centres
Community
empowerment
Strengthening Chronic Disease
Management at the primary care level
30
32. Initiatives to Improve Clinical Outcome
• The formation of Diabetes Team which consists of Diabetes Educator,
Medical Officer, Family Medicine Specialist (FMS), Nutritionist and
Pharmacist in every clinic as appropriate to their burden of diabetes
patients.
• FMS or senior Medical Officer in the clinic to do regular audits on green
book.
• Intensify and more frequent supervision especially by FMS of clinical staff to
ensure compliance to CPGs and related guidelines.
• Regular training and CMEs on diabetes care for all clinic staffs, and the state
office to monitor the numbers of training sessions conducted.
• Availability of module for health education for patients and a set of pre- and
post-test for patients, as published by Disease Control Division, MOH.
• The usage of the Diabetes Conversation Map.
• Further development of a Peer Support Group.
• Personalized care by Medical Officer in clinics with low to moderate burden
of loads, as appropriate in the individual clinic settings.
32
33. Overview of a Peer Support Group
• Patients becomes a trainer / facilitator, training his/her fellow
colleagues with the same disease.
• MOH responsible for developing the training modules,
conduct training and develop the implementation guidelines.
• Successful implementation of a Peer Support Group Program
has been shown to:
• Help patients understand their disease better;
• Help patients achieve good disease control; and
• Reduce rates of referral to hospitals due to complications.
• Rationale – patients are more likely to accept advise from
their peers or people living with the same condition.
33