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