importance of primary health care dr aslesh op assistant professor, community medicine, pariyaram...
TRANSCRIPT
IMPORTANCE OF PRIMARY HEALTH CAREDr Aslesh OPAssistant professor, Community Medicine, Pariyaram Medical College
Comparison of current prevalence of diabetes in above 18 years
Kerala India world0
2
4
6
8
10
12
14
16 14.8
9.5 9
Age standardized prevalence of di-abetes among >18 years
Thankappan KR, Shah B, Mathur P, Sarma PS, Srinivas G, Mini GK, et al. Risk factor profile for chronic non-communicable diseases: Results of a community-based study in Kerala, India. Indian J Med Res. 2010;131(1):53–63.
World Health Organization. Global Status Report On Noncommunicable Diseases 2014. 2014.
Diabetes in Kerala over last 25 year
27.3
16.214.6
19.6
5.9
16.3
4
y = 1.0179x - 2023.9R² = 0.6882
0
5
10
15
20
25
30
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012
%
Year
Prevalence of diabetes
1999 20100
2
4
6
8
10
12
14
3.4
13.1
Prevalence of diabetes in age group 30-40 years
Kutty VR, Soman CR, Joseph A, Pisharody R, Vijayakumar K. Type 2 diabetes in southern Kerala: variation in prevalence among geographic divisions within a region. Natl Med J India [Internet]. Jan [cited 2015 Apr 23];13(6):287–92
Jose R, Manojan KK, Augustine P, Nujum ZT, Althaf A, Haran JC, et al. Prevalence of Type 2 Diabetes and Prediabetes in Neyyattinkara Taluk of South Kerala [Internet]. Academic Medical Journal of India. 2013 [cited 2015 Apr 23]. Available from: http://medicaljournal.in/prevalence-of-type-2-diabetes-prediabetes
Detection , treatment and control of diabetes in Kerala
Aware Treated Controled0
10
20
30
40
50
60
70
8072
68
22
73
65
31
71 70
15
Allmalesfemales
Detection , treatment and control of hypertension in Kerala
Aware Treated Controlled0
5
10
15
20
25
30
35
40
45
50
37
27
9
30
21
6
44
33
11
Allmalesfemales
Coronary artery diseases
State reports a higher prevalence of coronary artery diseases when compared to other states in India 7.4% in rural (in 1991) 13.5% in urban(in 1995)
The estimated prevalence of coronary artery disease in the age group 20-69 years for 2015 is 10.1 %.(31)
*Kutty VR, Balakrishnan KG, Jayasree AK, Thomas J. Prevalence of coronary heart disease in the rural population of Thiruvananthapuram district, Kerala, India. Int J Cardiol [Internet]. 1993 Apr [cited 2015 Apr 24];39(1):59–70. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8407009**Begom R, Singh RB. Prevalence of coronary artery disease and its risk factors in the urban population of South and North India. Acta Cardiol [Internet]. 1995 Jan [cited 2015 May 7];50(3):227–40. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7676762***National Commission on Macroeconomics and Health. NCMH Background Papers·Burden of Disease in India. New delhi; 2005. p. 1–388. Available from: http://www.who.int/macrohealth/action/NCMH_Burden of disease_(29 Sep 2005).pdf
Stroke
Prevalence stroke among adults (>18 years ) in the state was 0.3%
The age adjusted annual incidence of stroke in Kerala in 2010 was 135 per 100,000 were more in males (143 )compared to females (128)
Ischemic stroke was the most common type of stroke ( 73 per 100000)
#Menon J, Joseph J, Thachil A, Attacheril T V, Banerjee A. Surveillance of noncommunicable diseases by community health workers in Kerala: the epidemiology of noncommunicable diseases in rural areas (ENDIRA) study. Glob Heart [Internet]. 2014 Dec [cited 2015 Apr 1];9(4):409–17. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25592794
##Soman CR, Kutty VR, Safraj S, Vijayakumar K, Rajamohanan K, Ajayan K. All-cause mortality and cardiovascular mortality in Kerala state of India: results from a 5-year follow-up of 161,942 rural community dwelling adults. Asia Pac J Public Health [Internet]. 2011 Nov [cited 2015 Apr 23];23(6):896–903. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20460280
Incidence of cancer in Kerala
Kerala (1) India (2) World (2)0
50
100
150
200
250
132
97
204
123
92
167
malesfemales
Per
10
0,0
00
1.Three Year Report of PBCR 2009-2011 [Internet]. [cited 2015 Apr 28]. Available from: http://www.ncrpindia.org/ALL_NCRP_REPORTS/PBCR_REPORT_2009_2011/ALL_CONTENT/Printed_Version.htm2 GLOBOCAN :Fact Sheets by Population [Internet]. [cited 2015 Apr 27]. Available from: http://globocan.iarc.fr/Pages/fact_sheets_population.aspx
Trend in incidence of cancer in Kerala
1991-92
1993-97
1998-02
2005-07
2009-11
0
20
40
60
80
100
120
140
109.2
87.896.6
132.3 132.6
87.181.1 80
114.9123.2
Thiruvananthapuram
males females
In 1
00
,00
0
1991-92
1993-97
1998-02
2005-07
2009-11
0
20
40
60
80
100
120
140
115.9 116.6
99.4 102.6
118.5
80.4 80.4 76 76.3
91.6
Kollam
Males Females
In 1
00
,00
0
*CI5 - Home [Internet]. [cited 2015 Apr 27]. Available from: http://ci5.iarc.fr/Default.aspx**Three Year Report of PBCR 2009-2011 [Internet]. [cited 2015 Apr 28]. Available from: http://www.ncrpindia.org/ALL_NCRP_REPORTS/PBCR_REPORT_2009_2011/ALL_CONTENT/Printed_Version.htm
Mul
tiple
mye
lom
a
Corpu
s ut
eri
Gallb
ladd
er e
tc.
Mel
anom
a of
skin
Lung
Brea
st
Ovary
etc
.
Panc
reas
Live
r
Conne
ctive
tissu
e
Stom
ach
Oesop
hagu
s
Nose
sinu
ses et
c.
geni
tal o
rgan
s
-100
-50
0
50
100
150
200
250
300
350
Change in cancer incidence in females from 1991-92 to 2009-11
%
Prevalence of chronic respiratory disease in Kerala
Kerala India0
2
4
6
8
10
12
10.1
3.53.1
1.9
Chronic bronchitisAsthma%
Jindal SK. Indian Study on Epidemiology of Asthma , Respiratory Symptoms and Chronic Bronchitis ( INSEARCH ) A Multi ‐ Centre Study ( 2006 ‐ 2009 ) Department of Pulmonary Medicine [Internet]. 2010. Available from: http://icmr.nic.in/final/INSEARCH_Full _Report.pdf
Chronic Kidney disease
Age-adjusted incidence rate of ESRD in India to be 22.9 per lakh population. 7500 new chronic kidney diseases every year
in Kerala Prevalence in hospitalized patients is 17 %
33 % in Kerala Main causes are diabetes nephropathy
and hypertensive nephrosclerosis*Modi GK, Jha V. The incidence of end-stage renal disease in India: a population-based study. Kidney Int [Internet]. 2006 Dec 25 [cited 2015 May 2];70(12):2131–3. Available from: http://dx.doi.org/10.1038/sj.ki.5001958**Singh AK, Farag YMK, Mittal B V, Subramanian KK, Reddy SRK, Acharya VN, et al. Epidemiology and risk factors of chronic kidney disease in India - results from the SEEK (Screening and Early Evaluation of Kidney Disease) study. BMC Nephrol [Internet]. 2013 Jan [cited 2015 Apr 22];14(1):114. Available from: http://www.biomedcentral.com/1471-2369/14/114***Rajapurkar MM, John GT, Kirpalani AL, Abraham G, Agarwal SK, Almeida AF, et al. What do we know about chronic kidney disease in India: first report of the Indian CKD registry. BMC Nephrol [Internet]. 2012 Jan [cited 2015 Apr 17];13:10. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3350459&tool=pmcentrez&rendertype=abstract
Levels of health care and the system in place
Tertiary careMedical college, special institutes
Secondary careCHC, TH, DH
Primary care_PHC , subcentre
Primary level
The “first” level of contact between the individual and the health system.
Essential health care (PHC) is provided. A majority of prevailing health
problems can be satisfactorily managed.
The closest to the people. Provided by the primary health centers.
WHAT IS PRIMARY HEALTH CARE
primary health care is essential health care made universally accessible to individuals and acceptable to them, through full participation and at a cost the community and country can afford
Secondary health care More complex problems are delt with. Comprises curative services Provided by the CHC, taluk district
hospitals The 1st referral level
Tertiary health care Offers super-specialist care Provided by regional/central level
institution. Provide training programs
Level of prevention and health care
Tertiary prevention
Secondary
prevention
Primary prevention
Tertiary
Secondary
Primary care level
PRINCIPLES OF PRIMARY HEALTH CARE
Equitable distribution
Community participation
Intersectoral coordination
Appropriate technology
Decentralisation
ELEMENTS OF PRIMARY HEATH CARE
Education concerning prevailing health problems and the methods of preventing an controlling them
Promotion of food supply and proper nutrition
An adequate supply of safe water and basic sanitation
Maternal and child health care including FP
Contd.
Immunization against major infections diseases
Prevention and control local endemic diseases
Appropriate treatment of common diseases
Provision of essential drugs
EXTENDED ELEMENTS OF PHC Expanded options of immunization Reproductive health needs Provision of essential technologies for
health Prevention and control of non
communicable diseases Food safety and provision of selected
food supplements.
FIVE COMMON SHORT COMINGS OF HEALTH CARE DELIVERY
Inverse care Impoverishing care Fragmented and fragmenting care Unsafe care Misdirected care
The Basic Requirements for Sound PHC (the 8 A’s and the 3 C’s)
Appropriateness Availability Adequacy Accessibility Acceptability Affordability
Assessability Accountability Completeness Comprehensivene
ss Continuity
Strategies of PHC
1.Reducing excess mortality of poor marginalized populations:
PHC must ensure access to health services for the most disadvantaged populations, and focus on interventions which will directly impact on the major causes of mortality, morbidity and disability for those populations.
2. Reducing the leading risk factors to human health:
PHC, through its preventative and health promotion roles, must address those known risk factors, which are the major determinants of health outcomes for local populations.
Strategies contd.
3. Developing Sustainable Health Systems: PHC as a component of health systems must
develop in ways, which are financially sustainable, supported by political leaders, and supported by the populations served.
4. Developing an enabling policy and institutional environment:
PHC policy must be integrated with other policy domains, and play its part in the pursuit of wider social, economic, environmental and development
policy.
Contd.
Government funded and delivered services with a centralized
Management of growing scarcity and downsizing
Bilateral aid and technical assistance
Primary care as the antithesis of the hospital
PHC is cheap and requires only a modest investment
Guiding the growth of resources for health towards universal coverage
Global solidarity and joint learning
Primary care as coordinator of a comprehensive response
PHC is not cheap. It requires considerable investment .