Non Communicable Diseases in the Non Communicable Diseases in the Region: Way ForwardRegion: Way Forward
MEETING OF AFRICAN MINISTERS OF HEALTHMEETING OF AFRICAN MINISTERS OF HEALTHOF ISLAND DEVELOPING STATESOF ISLAND DEVELOPING STATES
Praia, Cape Verde, 18 – 20 March 2009
Seychelles, 23rd to 25th of October 2006Seychelles, 23rd to 25th of October 2006
Global burden of diseases estimates– Double burden
8 common risk factors– Integrated approach– Surveillance– Primary Prevention– Prevention secondary and tertiary
• Evidence based• Local needs
Indian Ocean
Mauritania
Nigeria
Senegal
Gambia
Guinea Bissau
Liberia Sierra Leone
Coted'Ivoire
Togo
Benin
Mali
GabonEquatorial Guinea
Sao Tome & Principe
Angola
Democratic Republic ofCongo
CentralAfrican
Republic
Congo
Cameroon
United Republicof Tanzania
Zambia
Mozambique
Zimbabwe
BotswanaNamibia
Ghana
Malawi
Chad
Madagascar
Burundi
South Africa
Algeria
Niger
Ethiopia
Eritrea
Kenya
Rwanda
Uganda
Atlantic Ocean
Swaziland
Lesotho
Survey with data
Seychelles
Comoros
MauritiusMost advanced
Survey in field
STEP Survey Stage of development
February 2009
Guinea
Cape Verde
Burkina Faso
Trained
Percentage who ate less than 5 of combined servings of fruit & vegetables per day
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Percentage with low levels of activity (defined as <600 MET-minutes/week)
0%
10%
20%
30%
40%
50%
60%
70%
Percentage who are overweight or obese (BMI ≥ 25 kg/m2)
0%
10%
20%
30%
40%
50%
60%
70%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%(IMC ≥ 25 kg/m2) M
(IMC ≥ 25 kg/m2) F
Percentage who drank alcohol on 4 or more days in the last week
0%
5%
10%
15%
20%
25%
30%
Percentage with raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP)
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Summary of combined risk factors Summary of combined risk factors
current daily smokers
less than 5 servings of fruits & vegetables per day
low level of activity (<600 MET -minutes)
overweight or obese (BMI ≥ 25 kg/m2)
raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP)
Percentage with raised risk (at least three of the risk factors included above), aged 25 to 64 years old
0%
5%
10%
15%
20%
25%
30%
35%
40%
Mau
ritan
ie
Botswan
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Cap Ver
t
Niger
Mal
i
Mad
agas
car
RDCCIV
Algér
ie
Congo B
Bénin
Swazila
nd
Seych
elles
Moza
mbiq
ue
Eritre
a
Camer
oon
Zimbaw
e
Ethio
pie
Tobacco:Tobacco: key driver of NCD increase
80% of projected 8.3m tobacco-attributable deaths up to 2030 will occur in low- & middle-income countries
% currently use any form of tobacco% currently use any form of tobacco
Cape Verde 2007– 13.4
Comoros 2007– 18.1
Mauritius 2008– 13.7
Seychelles 2007– 26.6
% live in homes where others smoke in their presence% live in homes where others smoke in their presence
Cape Verde 2007– 13.9
Comoros 2007– 35.2
Mauritius 2008– 36.1
Seychelles 2007– 42.3
% think smoke from others is harmful to them% think smoke from others is harmful to them
Cape Verde 2007– 63.3
Comoros 2007– 62.9
Mauritius 2008– 70
Seychelles 2007– 55.5
% think smoking should be banned from public places.% think smoking should be banned from public places.
Cape Verde 2007– 78.9
Comoros 2007– 78.8
Mauritius 2008– 75
Seychelles 2007– 62.7
% students saw anti-smoking messages (30days)% students saw anti-smoking messages (30days)
Cape Verde 2007– 74.5
Comoros 2007– 76.6
Mauritius 2008– 84.9
Seychelles 2007– 84.3
% saw pro-cigarette ads in newspapers or magazines (30days) % saw pro-cigarette ads in newspapers or magazines (30days)
Cape Verde 2007– 53.2
Comoros 2007– 48.3
Mauritius 2008– 51.4
Seychelles 2007– 49.4
Global school-based student health survey (GSHS)
Percentage of students who drank so much alcohol that they were really drunk one or more times during their lives
Percentage of students who drank so much alcohol that they were really drunk one or more times during their lives
42.8
15.218
31.8
23.220.916.5
4.85.5
32.7
17.4
53.1
18.6
0
10
20
30
40
50
60
Zambia
UgandaSwazilandNam
ibiaKenyaBotswanaZim
babweSenegalTanzaniaGhanaM
auritiusSeychellesSwaziland
GSHS ( Studentsaged 13–15 years)
Percentage of students who spent three or more hours per day sitting and watching television, playing computer games, talking with friends, or doing
other sitting activities
Percentage of students who spent three or more hours per day sitting and watching television, playing computer games, talking with friends, or doing
other sitting activities
32.627.5
31
40.9
34.5
43.8
25.327.727.4
33.1
54.7
0
10
20
30
40
50
60
GSHS ( Studentsaged 13–15 years)
Way ForwardWay Forward
The global response to address NCDs: overviewThe global response to address NCDs: overview
A six-year Global Action Plan to address cardiovascular disease, cancer, respiratory disease and diabetes was endorsed by the WHO World Health
Assembly on 24 May 2008.
Global Strategy for the Prevention and Control of
Noncommunicable Diseases
2000
Prevention and Control of
Noncommunicable Diseases:
Implementation of the Global Strategy
2007implementation
in countries2004
Global strategy on Diet, Physical Activity
and Health
2003
WHO Framework Convention on
Tobacco Control
Global Strategy on Harmful Use of
Alcohol
2013
Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable
Diseases
2008
The regional response to address NCDs: overviewThe regional response to address NCDs: overview
Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable
Diseases
2008 2013 implementation
in countries2000
WHO AFRO strategy on NCD RC50
WHO AFRO strategy on
Health Promotion RC51
2001 2005 2007
Cardiovascular diseases RC55
Tobacco RC55
Diabetes Strategy RC57
Alcohol RC57
Cancer Strategy RC58
NCD Action Plan: 6 objectives
1. Raise the priority accorded to NCDs in development work
2. Establish/strengthen national policies and plans for prevention and control of NCDs
3. Promote interventions to reduce the risk factors for NCDs
4. Promote research for the prevention and control of NCDs
5. Promote partnerships for the prevention and control of NCDs
6. Monitor NCDs and their determinants & evaluate progress
Regional PrioritiesRegional Priorities
Primary Prevention
NCD Management at PHC
1. Primary Prevention1. Primary PreventionTo promote interventions to reduce the main shared
modifiable risk factors for noncommunicable diseases: tobacco use, unhealthy diets, physical inactivity and
harmful use of alcohol
Tobacco controlTobacco control
The MPOWER package, – Monitor tobacco use and tobacco-prevention policies– Protect people from tobacco smoke in public places and
workplaces– Offer help to people who want to stop using tobacco– Warn people about the dangers of tobacco– Enforce bans on tobacco advertising, promotion and sponsorship– Raise tobacco taxes and prices.
Promoting healthy dietPromoting healthy diet
Exclusive breastfeeding & ensure optimal feeding for all infants and young children;
Develop a national policy and action plan on food and nutrition, including the control of diet-related noncommunicable diseases;
Establish and implement food-based dietary guidelines reducing salt levels eliminating industrially produced trans-fatty acids decreasing saturated fats limiting free sugars responsible marketing of foods and non-alcoholic beverages
to children,
Provide accurate and balanced information for consumers
Promoting physical activityPromoting physical activity
Develop and implement national guidelines on physical activity for health;
Implement school-based programmes in line with WHO’s health-promoting schools initiative;
Ensure that physical environments support safe active commuting, and create space for recreational activity, by the following:
– ensuring that physical activity are accessible to and safe for all;
– introducing transport policies that promote active and safe methods of travelling
– improving sports, recreation and leisure facilities;– increasing the number of safe spaces available for active
play.
Reducing the harmful use of alcoholReducing the harmful use of alcohol
Under-age drinking
The harmful use of alcohol by women of reproductive age;
Driving or operating machinery while under the influence of alcohol (including all traffic-related injuries involving alcohol);
Drinking to intoxication;
Alcohol-use disorders;
The consumption of alcoholic beverages that have been illegally produced and distributed;
2. NCD Management at PHC2. NCD Management at PHCto implement and monitor cost-effective approaches for the early detection of cardiovascular diseases, cancers,
diabetes, CRD and establish standards of health care for common conditions integrating, whenever feasible,
their management into primary health care.
NCD Management at PHCNCD Management at PHC
In line with the Ouagadougou declaration on PHC
WHO has developed a package of essential NCD (WHO-PEN) interventions to integrate cost-effective interventions for the prevention and control of major NCDs into primary care level.
These protocols have been selected for the delivery of a minimum set of essential interventions addressing the four major NCDs (CVD, cancer, diabetes and chronic respiratory diseases) at PH level.
Protocols have been prepared taking into consideration the limitations in low resource settings.
Application of ProtocolsApplication of Protocols
For Scenario 1 (Non Physicians)
For Scenario 2 (Physicians)
Assessment and management of cardiovascular risk in primary health care
Assessment and management of cardiovascular risk in primary health care
WHO/ISH Pocket guidelines for predicting 10-year risk of a fatal or non-fatal major heart attack and stroke risk based on
– Age
– Sex
– Blood pressure
– Smoking status
– Blood cholesterol
– Presence or absence of diabetes
and appropriate interventions for each.
NCD ManagementNCD Management
The implementation of the WHO PEN interventions – requires training,– adequate financing, – provision of essential medicines and equipment,
Generic protocols to be adapted
NCD national capacity survey2010 - 2013
NCD national capacity survey2010 - 2013
Institutional Capacity
Status of CNCD relevant policies, strategies, action plans
Health Information Systems, surveillance and surveys
Health Promotion & Primary Prevention
Health services for CNCD Screening, treatment and care
Thank you