Prince Hussein Hospital

8/7/2019 Prince Hussein Hospital

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Women HealthTheory & practice

The Gap


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To keep women in:

the best state of,physical, Mental &Social

wellbeing all through herlife stages


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People with osteoporosis

do not just die;they slowly break apart.

Linda Johnson


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Osteoporosis is a

disease of women


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0

10

20

30

40

50

60

70

80

Hip

Fracture

Lung

Cancer

Breast

Cancer

Cervical

Cancer

Ovarian

Cancer

Endo-

Metrial

Cancer

Ischemic

Heart

Desease

Stroke

Mortality (x 1,000)


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Etiology

1. genetic parameters (Danker-Hopfe and Delibalta)

2. socioeconomic conditions (Belmaker 1994),

3. general health and life-style (Parazzini et al.

4. nutritional status (Osteria 1994; et al.1997),

5. physical activity (Malina 1983; Baker 1985),

6. altitude level (; Kapoor and Kapoor 1986)


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Number of Dxa Machines

Number of DEXA

0

20

40

60

80

100

120

140

160

Cairo Shebin El Kom Mansoura Beny Sweif El MenyaNumber of DEXA


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Access to Treatment

Access to Treatment

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

Cairo

MeetHalfa

ElAhraz

ShebinElKom

KomBerra

ElBagour

Mansoura

Talkha

BerKeen

BenySweifSeds

ElFashn

ElMenya

Maghagha

ElBayaho

Access to Treatment


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Women Understanding

About Osteoporosis

Women Understanding

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Cai

ro

Mee

tHal

fa

ElAhr

az

Sheb

inElK

om

Kom

Ber

ra

ElBag

our

Man

sour

a

Talk

ha

BerK

een

Beny

Swe

ifSe

ds

ElFas

hn

ElM

enya

Mag

hagh

a

ElBay

aho

Women

Understanding


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Fract re rate%

treate at e ts ffere ce eff cac f rom control a ent

Power

80%

Power

90%

10 30 50 10 30 50

1.2 235000 18 080 4178 313700 23 944 5484


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Age T- score

-5 -4.5 -4 -3.5 -3 -2.5 -2 -1.5 -1

50 54 6.0 3.6 2.3 1.5 1.1 0.9 0.7 0.6 0.5

55 59 5.5 3.5 2.3 1.7 1.2 1.0 0.8 0.7 0.6

60 64 5.3 3.5 2.5 1.8 1.3 1.1 0.8 0.7 0.6

65 69 5.9 4.1 3.0 2.3 1.7 1.4 1.1 0.9 0.8

70 74 7.0 5.2 3.9 3.0 2.4 1.9 1.5 1.3 1.1

75 79 8.5 6.4 4.9 3.8 2.9 2.3 1.8 1.6 1.4

80 84 10.0 7.6 5.9 4.5 3.5 2.8 2.2 1.9 1.6For all age bands, the results for alendronate letto the most favourable cost per QUALY results,followed by the results of risedronate.

National Institute for Health and Clinical Excellence - UK


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Drug Vertebral Fx Pelvisand

ot er Femural Fx

Proximal humerus

rib sternum

sca ula & fibulafx

Alendronate 44%0.46 0.68 38%0.40 0.98 19%0.68 0.97Trials/Participants 4/7039 4/7881 6/ 9973

Risedronate 39%0.50 0.75

26%

0.59 0.93

24%

0.64 0.91

Trials/Participants 3/2301 3/11770 5/12399

Etidronate 60%0.20 0.83

50%

0.05 5.34

4%

0.64 1.69


Raloxifene35%

0.53 0.97

13%

0.66 1.96

8%

0.79 1.07


Teriparatide 65%0.22 0.55

50%

0.09 2.73

35%

0.43 0.98



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Substandard drugs is a big problem - antibiotics,antimalarials, antituberculosis drugs included.

Incorrect

amount

17%

No active

ingredient

60%Other errors

7%

Incorrect

ingredient

16%

breakdown ofdata on325 cases ofsubstandarddrugs -including antibiotics, theworld to WHO database

Is quality of pharmaceuticals aproblem?


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SafetySafety


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Best treatment compliance

reported in thissurvey was 7months in Mansoura.

andThe most frequent rate was

4 monthsreported in most of

thestudy sites.


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Why women Do Not

Comply?


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Because they are

women


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Drug price


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Osteoporosis treatment

expenditure (L.E.) in Egypt

0

2000000

4000000

6000000

8000000

10000000

12000000

14000000

16000000

18000000

20000000

LE

S

2003

LE

S

2004

LE

S

2005

LE

S

2006

LE

S

2007

LE

S

2008

E

S

2009

ACTONEL

FOSAMAXBONAPEX

RISALDENE

MIACALCIC

PROTELOS

ZOMETA

EVISTA

RALOX


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Drug units sales in Egypt.

0

20000

40000

60000

80000

100000

120000

140000

160000

180000

200000

Units

Y/2

003

Units

Y/2

004

Units

Y/2

005

Units

Y/2

006

Units

Y/2

007

Units

Y/2

008

Units

Estim

ate20

09

ACTONEL

FOSAVANCE

FOSAMAX

MIACALCIC

BONIN NASAL

MIACALCIC PLUS

PROTELOS

EVISTA

RALOGEN


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Patients days of therapy (1000)

in different countries.

0

20000

40000

60000

80000

100000

120000

140000

160000

Q

TRMar/200

3

QTR

Sep/200

3

Q

TRMar/200

4

QTR

Sep/200

4

Q

TRMar/200

5

QTR

Sep/200

5

Q

TRMar/200

6

QTR

Sep/200

6

Q

TRMar/200

7

QTR

Sep/200

7

Q

TRMar/200

8

QTR

Sep/200

8

Q

TRMar/200

9

QTR

Jul/20

09

Total France

Total italy

Total Lebnon

Total KSA

Total Egypt

Total Jordan

Total Arab


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2003 2004 2005 2006 2007 2008 2009

Egypt 5,455 5,537 5,703 5,768 5,681 5,847 5,921

ebanon 4,403 5,344 5,304 5,523 5,973 6,099 8,885

KSA 1,156 1,420 1,917 2,771 2,945 3,146 4,650

Jordan 760 736 810 901 952 980 811

France 213,619 233,525 256,538 276,239 301,966 322,906 338,822

IMS international

Patients days of therapy(000) in

Arab countries compared to France


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TheTragedy of Osteoporosis

1. Painless disease

2. First presentation usually by the end point.

3. Complex etiology.

4. Difficult diagnosis.

5. Very poor compliance for treatment.

6. No cost reimbursement by MOH.


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Our concern is:Our concern is:

All aspectsAll aspectsrelated torelated to

Women HealthWomen Health


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Health stresses that affect

women mainly due togenderdifference

Not necessarily absolute

(pregnancy &Labour)

But also relative

Anemia, osteoporosis, ca.breast &

colon.


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0

10

20

30

40

50

60

70

80

1000 B.C. 100 B.C. 1900 2000

Women LifeE ect ncy


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Women

HealthS

urveyEgypt

2005-2009


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Results


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Most frequent health problemsin Egyptian women.

28%

17%

24%

13%

16%

2%

5% 6%

0

5

10

15

20

25

30

BMIb

oe32


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Most frequent health problems

encounteredduring ourstudy.

Anemia28%

Hypertension 24%

Hyperlipidemia 17%


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Thepercentage of level ofeducation

Level ofeducationLevel ofeducation No.No. (%)(%)

Lessthan a preparatory schoolLessthan a preparatory schoolincluding Illiterates (%)including Illiterates (%) 1252812528 69.669.6

HighHigh--school (Preparatoryschool (Preparatory--

Secondary) graduate (%)Secondary) graduate (%)31053105 17.2517.25

University Graduates (%)University Graduates (%) 23672367 13.1513.15

69.60%

17.25%13.15%

0.00%

20.00%

40.00%

60.00%

80.00%

Less than a preparatory school including Illiterates (%)

High-school (Preparatory-Secondary) graduate (%)

University Graduates (%)


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TheIncidence & Distribution Of Monthly Income

Monthly incomeMonthly income

Egyptian poundEgyptian pound

Freq.Freq. %%

100100--300 LE300 LE50045004 27.8%27.8%

300300--500 LE500 LE1137611376 62.3%62.3%

500500--1000 LE1000 LE12151215 6.75%6.75%

>1000 LE>1000 LE567567 3.15%3.15%

27.80%

62.30%

6.75%

3.15%

0.00%

20.00%

40.00%

60.00%

80.00%

Monthly Income

100-300 LE 300-500 LE 500-1000 LE >1000 LE


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In a report measuring the global gender gap

:placed Egyptian women last in the league table

of 58 nations.

The critical criteria used in this study were:

1. Economic opportunity .

2. Participation .3. Health and wellbeing .

4. Educational attainment .

5. Political empowerment.

The World Economic Forum in

Sharm El Sheikh 2005


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Here are few examples:

There are nearly 37 million women in Egypt.

Of the working adult population of Egypt, only 22% are

women.

On average, working Egyptian women earn nearly one

third less than men.

Only 9% of working women are in managerial and

administrative jobs.

More than 22% of adult women are unemployed

compared with just more than 5% unemployed men.

The numbers are staggering.


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One third of women aged 15-24 years cannot read or

write

In 2000, 84 women died of pregnancy and birth for

every 100,000 babies born alive

Of those 84 mothers, 46 were 15-19 years old

Of all women aged 15 19 only 15% are or were ever

married

Egypt ranks 82nd in the world on her maternalmortality ratio and 123rd on her infant mortality ratio

Of the 545 members ofParliament, only 9 are

women (2% representation for 50% of the population)


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They also faceenormous challenges

Women in Egypt

have a problem.


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Preventive medicine

Prevent the disease

better than treating it.(Attack the cause)


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Check up policy

Prevent the risk

factor


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Compression of Morbidity

0 20 40 60 80100

} Latent

Severe Disease

ClinicalThreshold


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Comprehensiveapproachfor women health problems


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Comprehensive approach

entails many diseases and social

factors :

as state of housing, education,

culture & financial state.


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But in underdeveloped countries most of the health

expenditure for diagnosis & treatment are directed

mainly towards other problems like infectious

diseases and life threatening conditions

That are supplied for free or reimbursed for the less

privileged people.

which is not the case in women health issues.


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The climacteric and HRT

Development of HRT 1889 Brown-Sequard pioneered the concept of HRT 1893 Injected ovarian extract used

1923 Allen & Doisy isolated ovarian hormone (estrogen)

1930 Dodds & Robertson used oestrin

1941 Organon Labsdevelopedestradiol implant 1943 Premarin was introduced

1952 Organon developedestriol tablets (Ovestin)

1966 Robert Wilson wroteFeminine forever

1975 Unopposedestrogen establishedasarisk factorforendometrial carcinoma

1980s Introduction ofsequential therapiesand transdermaldelivery ofestrogens

1990s Introduction of continuous combined therapies

Development ofTissue-Specific therapiesand SERMs


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Early Study terminationon July8th 2002(5.2 years)

Increasedrisk ofbreast cancer1.26 8 more cases / 10000

Increasedrisk of CHD 1.29 8more cases / 10000

Stroke1.41 9more cases /10000

Pulmonary embolism 1.13 7more cases / 10000


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I have a dream.

WE&

Me & all of you..

Women Health stakeholders..

Will come to a detailed programme for the

optimum policy for better Quality of Women's Life


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The programme

Must beconsistent

,institutionalizedand

self supported


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Mission

is to help women

from all walks of

life to fulfil theirpotential.


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This fulfilment is

achievable throughbetter quality of life in all its aspects:

health and wellbeing; economic independence;

social and political participation;

access to information;

achieving higher intellectual capabilities through

education and knowledge;

THE EXERCISE OF INFORMED CHOICE; and the awarenessof womens issues and rights worldwide


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ISA

WHER

International Society for theAdvancement of Womens

Health and Rights


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Adolescents.

Adults in their reproductive

years.

women in the change of life and

the elderly

ISAWHER has its focus

on women in 3 groups:


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ISAWHER addresses the critical factors in

achieving better quality of life for women

and reducing the gender gap

Health and wellbeing.Economic opportunity.

Economic participation.

Educational attainment.

Political empowerment.

Documents

Prince Hussein Hospital