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Challenges of NCDs in Palestine***

Heidar Abu GhoshDirector of

Chronic Diseases Program***

Palestinian Medical Relief Society

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NCDs of Interest..

• Heart

• HTN

• Diabetes

• CVD

• Cancer (Breast)

• Dyslipidemia

• Obesity ?!

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Targeted Diseases• High prevalence

• An increasing morbidity and mortality burden

• An increasing economic, social, and psychological burden

• Early detection improves prognosis

• Public awareness is crucial for prevention

• Comprehensive management is generally absent

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How High is the Risk ?

• After the age of 35 years:– 1 out of six may develop diabetes– 1 out of 3 may develop hypertension– 1 out of 2 have dyslipidemia– 2 out of 3 are overweight – 2 out of 5 are obese– 1 adult male out of 3 is a smoker

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Global Trends

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Estimated prevalence of diabetes and number of cases of diabetes in millions. (Adapted from King et al, 1998).

RegionYear199520002025

WorldPrevalence %4.04.25.4

Number (millions)

135.3154.4300

Developed countries

Prevalence %5.96.27.6

Number (millions)

5154.872.2

Developing countries

Prevalence %3.33.54.9

Number (millions)

84.399.6227.7

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NCDs in LD Countries

• In LD countries –like Palestine- that experience the double burden of diseases, NCDs contributed to more than half of total mortality and 40% of total disease burden

• The large burden of NCDs in these countries is characterized both by the increased incidence of diseases and the relatively early age at which they appear

• NCDs also contribute largely to disability in both the developed and developing countries.

Source: World health report 2003

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NCDs in Palestine

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Current Status

• Demographic and Epidemiological Transition

• Progressive UrbanizationCaloric Excess Less Physical ActivityIncreased Tobacco ConsumptionPredominance of Overweight and ObesityQualitatively Poor Diet

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Demographic & Epidemiological Transition

• Better control of communicable diseases

• Relative increase ageing of populations

• Decrease in IMR

• Socio-economic transformation

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Demographic Characteristics

• Number of people in WBG is 3,117,290– WB: 1,992,105– Gaza: 1,125,185

• Children under the age of 15years comprises 47% of the population

• Those under 30 years old comprise 70%

• The proportion of elderly (65years and older) is 3.3% (PCBS: 2000)

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Risk Factors

Modifiable: Caloric excess-

obesity Diet Physical inactivity Smoking

Non- modifiable: Age Gender Ethnic group Family history Personal history

STRESS

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Nutrition

• Traditional nutrition– High fibers, whole

grains– Less animal fat– More complex

carbohydrate

• Modern diet”:– Less fibers ,refined

grains– More animal fat– More simple sugar

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Qualitatively Poor Diet

• High-fat (cholesterol )• Unsaturated fatty acids • Rapidly absorbed carbohydrates • Fiber• Salt• Vitamins

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Urbanization

Caloric Excess Less Physical ActivityIncreased Tobacco ConsumptionPredominance of Overweight and ObesityQualitatively Poor Diet

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Duality of Health Problems

• Modern diseases

- Diabetes Mellitus

- Hypertension

- Coronary heart diseases

- Cancer.

• Diseases of underdevelopment

- Infectious diseases

- Malnutrition

- Poor housing conditions

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Leading Causes of Death

DiseasePalestineIsraeli Arabs

Global

Infectious diseases

6.6533

CVD304230

Cancer191812

D.M.2.32.72

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Adult mortality in Palestine (2002)

CV

D

CH

D

HT

N

D.M

.

Res

pir

ato

y

Ca

nce

r

Acc

iden

ts

Sin

ilit

y

15.3 15.1

5.6

11.6

3.2

9.42

0

2

4

6

8

10

12

14

16

MoH:2004

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Diabetes Mellitus

• Diabetes is more prevalent than in Europe and North America

• It is estimated that the prevalence in the population aged 20years and above is more than 10%

• Our data showed a prevalence of 19% for people of 35years and above

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Cancer

• Rare published reports

• It is becoming a major public health concern

• The second reported cause of death after CVDs– The most common: Breast in females and

lung in smoking males

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Leading cause of cancer mortality in Palestine

0 2 4 6 8 10 12 14 16

bronchus & lung

breast

leukaemia

colorectal

brain & other part of NS

liver

stomach

prostate

non Hodgekin lumphoma

pancereas

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PMRS CHRONIC DISEASES

PROGRAMME

“ A CALL FOR ACTION”

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A Different Approach

• A comprehensive approach in the management of diseases:

• Prevention– Life style modification– Health promotion

• Early detection• Proper treatment

• Train and support management at PHC level

• Establish a good referral system

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Implementation

• The goals are to be met through different activities at:– The Chronic Disease Center– The Mobile Clinic– PMRS health centers

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Components

Prevention, Early DetectionAnd

Health Promotion

Surveillance, Data Collection,

And Research Proper Management

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Activities

• Activities include:– Training– Screening– Health Education– Early diagnosis – Proper Management– Data collection & Research– Coordination and cooperation– Advocacy & Lobbying

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Screening

• Every male and female over 35 years:– Glucose level in blood– Lipid profile– Blood pressure– Body Mass Index

• Every female over 25 years:– Breast examination

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Mobile Clinic

• More than 11,000 people screened fpr NCDs

• 68% were women• 7800 women were

screened for breast abnormalities

• All of them know how to do self breast examination

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The Chronic Diseases Center

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The Chronic Diseases Center

• A unique center in Palestine with a holistic approach for management of NCDs

• Management of heart diseases, diabetes, hypertension, and dyslipidemia

• Risk assessment

• Early detection of NCD through diagnostic procedures

• Counseling

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Diagnostic Procedures

• Patient’s and family history• Blood pressure• Weight and height• Dr’s examination• Upon need:

– ECG– Echocardiography– Treadmill– Holter

• Counseling

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Some Results FromSome Results From

PMRS Screening ServicesPMRS Screening Services

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Characteristics of PopulationCharacteristicMalesFemalesBoth

Mean age (years)49.6246.3347.2

Mean weight (Kg)79.6373.6775.25

Mean height (cm)170157160

Mean BMI27.6329.8529.26

Smoking(%) 34.81.410.2

High fat nutrition (%)

92.896.995.8

Low physical activity

64.367.266.4

Stress(%) 88.974.678.4

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Triglycerides (mg/dl)

Males155207.5

Females135.5191

T. cholesterol (mg/dl)

Males194.7210

Females191.3212.9

LDL (mg/dl)Males126.9129.2

Females114.7130.8

HDL (mg/dl)Males38.637

Females50.146

Selected factors associated with diabetic status

DM

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Cost of chronic diseases

• Economic

• Impact of the quality of life

• Decrease the productivity of individuals

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A CHALLENGE AND AN OPPORTUNITY

• The rapid rise of noncommunicable diseases represents one of the major health challenges to global development in this century. This growing challenge threatens economic and social development as well as the lives and health of millions of people

Source: World health report 2003

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A CHALLENGE AND AN OPPORTUNITY

• Noncommunicable diseases are estimated to have contributed to almost 60% (31.7 million) of deaths in the world and 43% of the global burden of disease.

• Based on current trends, by the year 2020 these diseases are expected to account for 73% of deaths and 60% of the disease burden.

Source: World health report 2003

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A CHALLENGE AND AN OPPORTUNITY

• Developing Countries suffer the greatest impact of noncommunicable diseases.

• The total number of deaths attributable to noncommunicable diseases, 77% occurred in developing countries,

• The disease burden represents, 85% in these countries.

Source: World health report 2003

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LESSONS LEARNED

• Noncommunicable diseases are to a great extent preventable through interventions against the major risk factors and their environmental, economic, social and behavioural determinants in the population.

• A comprehensive long-term strategy for control of noncommunicable diseases must necessarily include prevention of the emergence of risk factors in the first place.

Source: World health report 2003

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Chronic Disease Management

• All treatment plans and education programs must be adapted to the cultural and social environment for the patients.