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

a

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