national ncd program in oman

Ministry of HealthOman

National NCD Program in Oman

Dr. Ali Jaffer MohammedAdvisor Health Affairs MOH

1


Presentation Overview

• Five Year Plans

• NCD’s Burden in Oman

• Diabetes as an example

• Program Implementation

-National Level

-District Hospital level

-PHC level

-Community Level 2


The Five year Plans

3 8th Five year plan 2011-20157th Five Year Plan 2006-2010


Five Year Plan -Domain 13:NCD’s 7th Five Year Plan 2006-2010 8th Five year plan 2011-2015

4


Scope & Rational• High Prevalence of NCDs in Oman (Ages

20+ years): Behavioral/individual Risk factors

• Diabetes 12%• Hypertension 35%• Dyslipidaemia 40%• Overweight & obesity 48%• Tobacco use 23%

14.7%Source: OWHS-2008 (2008) (2011)

5


Atherosclerosis, cardiovascular diseaseAtherosclerosis, cardiovascular disease

Central/abdominal obesity 24.6%

High FPG 18.1%

HBP 23.1%

MicroalbuminuriaHigh TG 20.7%

Prevalence of metabolic syndrome

Oman 21%USA23%

Endothelial dysfunction

Insulin Resistance Syndrome (Metabolic Syndrome)

Low HDL 75.4%

Source: Nizwa 2001 6


Deaths attributable to diseases and injuries, all ages, Oman, 2002.

Source :WHO Global Burden of Disease 2002.

Total Deaths attributable to NCDs =62%

7


Disability-adjusted life years lost attributable to diseases and injuries, all ages, Oman, 2002.

Source: WHO Global Burden of Disease 2002

Total DALYs lost attributable to NCDs=23%

8


RationalIn the WHO Global Action Plan for Prevention

and Control of NCD objective # 3 is

So the Oman NCD prevention and control program is carrying out the activities at different health care levels

To promote interventions to reduce the main shared modifiable risk factors for non-communicable diseases : tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol.

9


The Top 10s (prevalence %) Till 2010 Oman was ranked in top 10, but in 2011 when the

International Diabetes Federation(IDF) recalculated the prevalence using different criteria, it has become 43rd Rank with a 10.75%

prevalence

(

IDF Atlas, V5, 2011

8th

43rd 10.7543. Oman

10


Country/territory Comp. prevalence (%) WHO Standard

Kuwait 21.10

Lebanon 20.17

Qatar 20.17

Saudi Arabia 20.02

Bahrain 19.88

UAE 19.22

Egypt 16.94

Libyan 14.19

Jordan 12.37

Iran 11.34

Oman 10.75

IDF Atlas, V5, 2011

6th

To

11th 11


Annual and Cummulative Number of People with Diabetes on the Register

3590 3487 3548 4177 4372 4862 5167 5482 5393 5413

2338627432

31704

37286

42017

48972

5459957167 56036

61583

0

10000

20000

30000

40000

50000

60000

70000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Year

No. o

f Cas

es

New registered diabetic Total registered diabetic

Annual Health Reports 2000-2009

>40 years population= 535344 (2011 data )

=11.50%

12


40-59 Years Old Most Affected

0

200

400

600

800

1000

1200

1400

1600

1800

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Year

No.

of C

ases

20-29

30-39

40-49

50-59

60-69

70+

Annual Health Reports 2000-200913


Action by in MOH

• High Political Commitment

• Established NCD Department 2003– Priority Diseases section (DM, CVD, Cancer,

Renal)– Specific Diseases (eye, ear)– Mental Health– Tobacco Control

• Formation of National Diabetes Committee

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Surveillance of NCDs• Oman-pioneered applying the WHO

protocol for the Diabetes Survey in 1991,• Then Surveys were carried out 10 yearly-

in 2000, and 2008(as part of Oman WHS

• National Diabetes Register

15


16

Baseline

First Year

Five years

Twelve years

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•Risk Factors(enter the number) •Weight( Kg )• Height (cm)• Duration of Diabetes•Clinical findings - Blood Pressure Peripheral Pulses Neuropathy Fundus Retinopathy Foot Ulcer •Laboratory Investigations -Blood Glucose-(Fasting &2 hrs pp) -OGTT –(fasting & 2 hr pp) -Fasting Lipids-(cholesterol, LDL, HDL,TG) -Renal Function ( Blood urea, creatinine, Urine-protein, sugar, ketones) -HbAIC -ECG•Type of Diabetes •Treatment • Remarks


Actions: At District Hospital

–Distinct clinic for diabetes• Specialist physician

• Nurse

• “Educator”

–Medication for Rx of DM-–Glycated HbA1c

•Insulin•Oral hypoglycemics•Antihypertensives•Statins are available at all Care levels.The Higher PHC Committee and Diabetes Committee will approve new medicines as per requirement 17


Diabetic clinics in Poly Clinics

8

10

12

14

16

18

20

2005 2006 2007 2008 2009

Year

Clin

ics

diabetic clinics in PC

Target by 2010

Department of NCD, MOH, Oman

18


Combined Clinics

0

5

10

15

20

25

2005 2006 2007 2008 2009

Year

Cli

nic

s

DM & Obgyn

Target


19


At PHC level

30

61

88 90100

50 50 50 50 50

0

20

40

60

80

100

120

2005 2006 2007 2008 2009

Mini Diab & HTN ClinicsTarget


Increase in Mini-Diabetes Clinic

20


… At PHC • Training of GPs

and Nurses

21


22


Diabetic FootTraining Omanis on Podiatry (Outside Oman) + (in Oman)

• In 2008 , 5 Omanis were sent to Australia for doing their BSc IN Podiatry at La Trobe University

• They then carried out Training for Nurses in Podiatry in Oman.

23


Training for Nurses in Podiatry carried out by Glasgow Caledonia University

24


Nurse-Run in Foot Clinics

1 1 1

15

23

0

5

10

15

20

25

2005 2006 2007 2008 2009

Year

No

. of

Clin

ics

Diabetic Foot Clinics


25


1

2

4

5

3

23

1

1

0

1

Distribution of Diabetes Foot

Clinics (April 2009)

UAE

Yemen

Kingdom of Saudi Arabia

Arabian Sea

Oman Sea

26


Reduction in Amputation

05

10

1520253035

404550

2001 2002 2003 2004 2005 2006 2007 2008 2009

Year

Am

pu

tati

on

s/1

0,0

00

Pa

tie

nts

/yr

Foot amputation


27


SCREENING TOOLS

Secondary Prevention

28


Non-Invasive Tool

Diabetes Risk Score(Has Not been implemented in Oman

as Screening for Common NCDs

for >40 years old

is implemented

29


2.4.1 The National NCD Screening Program 2006

30


31


In PHC• Screening for common NCD

conditions: (only for 40+ years)

– Diabetes (FBS)– Hypertension (BP measurement)– Chronic Renal disease (GFR)– Dyslipidaemia (TC, HDL, LDL, TG)– Obesity (BMI, WC)

32


NCD Screening Results (2008)

No. Screened

Males Females Both

6,785 (38%)

10,894 (62%)

17,679

BMI>30 23% 36% 31%

Abnormal WC

54% 76% 68%

Pre-HTN 15% 14% 14%

HTN 21% 19% 19%

Pre-DM 36% 35% 35%

DM 8% 6% 7%

High Choles. 43% 47% 46%

eGFR < 90 32% 26% 28%33


At Community Level

34


Community Based Initiatives

• The Nizwa Healthy Lifestyle project – WHO Community Based Program supported by MOH.

-1st baseline risk factor survey.

- In 2010 Evaluation of project was done by

WHO Consultant.

-It has been extended to other areas like Sur etc.

• School Health Program -The Health Promoting Schools program

-Facts of Life

35


Tobacco Control Oman

• Oman Ratified FCTC 2005

• Smoking ban in all public places

• Pictorial Health Warning ( all GCC)

• Maintaining the status quo is a big challenge

-due to tobacco lobbyists

-Increased Shisha useage in

older age group in both men and women

36


Challenges (1)• PHC structure needs further changes• Inadequate number trained staff to deal with

complex NCD conditions• Unavailability of latest medications

(e.g.insulin Analogue) due to cost constraints

• Limited lab services for tests in PHC –No electronic linkages for test results from Hospitals

37


• Need for electronic record system for defaulters follow-up, monitoring & evaluation

• Shortage of health educators

Challenges (2)

38


Thank You

39

national ncd program in oman

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