View
218
Download
4
Category
Preview:
Citation preview
The Non Communicable Disease Crisis and
Reproductive HealthPSRH BIENNIAL MEETING
APIA, SAMOA, 9-12 JULY, 2013PROF RAJAT GYANESHWARFIJI NATIONAL UNIVERSITY
BACKGROUND
LITERATURE REVIEW
ANALYSIS OF IMPLICATIONS FOR THE PACIFIC
RECOMMENDATIONS
OUTLINE OF PRESENTATION
DEFINITIONS
NCDs RH
DIABETES
CARDIOVASCULAR DISEASE
CHRONIC RESPIRATORY DISEASE
CANCER
SEXUAL HEALTH
FAMILY PLANNING AND INFERTILITY
MATERNAL AND CHILD HEALTH
STIs & CANCER
SMOKING - foetal and maternal issues
NUTRITION - Diabetes, hypertension
ALCOHOL - foetal alcohol synd, STIs, preg, cervical ca.
PHYSICAL ACTIVITY - obesity, osteoporosis
NCD RISK FACTORS
MENSTRUAL PROBLEMS FERTILITY ISSUES
INCREASED PREGNANCY RISKS URINARY AND FECAL INCONTINENCE PELVIC FLOOR LAXITY
POST MENOPAUSAL BREAST CANCER ENDOMETRIAL AND OTHER CANCERS.
OBESITY
Polycystic Ovarian Syndrome – obesity, excessive body hair and anovulation
- Common problem in the Pacific- Weight loss is first line of treatment ( Hollmann et al. Human Reproduction. 1996;11:1884-91)
- Life style factors important in achieving
weight loss. ( Huber-Buchoholz M et al. J Clin Endocrinol Met.
1999;84:1490-4
OBESITY AND MENSTRUAL PROBLEMS
REDUCED FECUNDITY AND INCREASED TIME TO CONCEPTION
( WiseL LA et al. Human Reprod. 2010; 25:253-264)
HIGH RATES OF INFERTILITY ( British Fertility Society Policy and Practice Guidelines)
LOWER RATES OF SUCCESSFUL PREGNANCY AFTER FERTILITY TREATMENT
( Maheshwari A et al. Human Reproduction Update. 2007;13:433-444)
OBESITY AND FERTILITY
INCREASED RISK OF : DIABETES (x2 – 5 depending on BMI) HYPERTENSION AND PET (X3.5) PRE TERM DELIVERY LARGE BABY AND SHOULDER DYSTOCIA CAESAREAN DELIVERY (Linear assoc with BMI) PPH PULMONARY EMBOLUS COST AND LENGTH OF STAY(( Weiss JL et al. Am J Obstet Gynecol 2004, O’Brien TE eta al. Epidemiology 2003, Kabrehel C et al. Obesity 2009,
Scott-Pillai R et al 2013, BJOG Torloni MR et al. J Matern Fetal Neonatal Med. 2009)
OBESITY AND PREGNANCY
INCREASED RATES OF : - POST MENOPAUSAL BREAST CANCER
- ENDOMETRIAL CANCER
- OTHER CANCERS - gut , liver, gall bladder, pancreas and kidney
(Renehan AG et al. Lancet 2008;371(9612): 569)
(Calle EE et al. N Engl J Med. 2003;348(17):1625)
OBESTITY AND CANCER
Each day : 50,000 women die from NCDs 1000 maternal deaths More women die due to : cardiovascular disease cancer respiratory disease (WHO list of 10 leading causes of death in
women)
NCDs and Female Mortality
33% of Fijian women (15-24 age group) are overweight or obese ( 2002 STEPS survey)
Obesity rates have trebled between 1993 and 2004. ( Fiji National Nutrition Survey 2004)
Obesity rates of between 30- 75% reported in 25-64 year olds in the Pacific (STEPS surveys)
OBESITY IN THE PACIFIC
SMOKING – 53.2 % of women in Nauru smoke.Rates high for Kiribati,Tokelau, Wallis and Fortuna )
ALCOHOL – 50% Cook Is women
HYPERTENSION – 27.5% American Samoan women
DIABETES – 42.4% - 12%
NCD RISK FACTORS - STEPS SURVEY
RISK FACTORS COMMON AND MODIFIABLE
HEALTH PRIOR TO, DURING, AND AFTER PREGNANCY AND CHILDBIRTH CAN HAVE LONG TERM HEALTH IMPLICATIONS
MCH PROGRAMS SHOULD INCLUDE NCD INTERVENTIONS
OPPORTUNITY TO MAKE A DIFFERENCE
Empower women and girls to care for their health better – menstrual problems, fertility issues, pregnancy care.
New approach to pregnancy care – weight gain,- nutrition,- cancer screening,- physical activity
PRACTICAL SUGGESTIONS
Emphasis on health education
Empowering women to take sound decisions about risk taking behaviour.
Take opportunity during antenatal visits to counsel, educate
Caring for women and girls
Recommended