who cindi macedonian action plan, 2002-2007

8/14/2019 WHO CINDI Macedonian Action Plan, 2002-2007.

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INTEGRATED COMMUNITY AND PRIMARY CARE BASEDINTEGRATED COMMUNITY AND PRIMARY CARE BASED

PREVENTION AND CONTROL OF CARDIOVASCULAR ANDPREVENTION AND CONTROL OF CARDIOVASCULAR AND

OTHER NCD IN FYR of MACEDONIAOTHER NCD IN FYR of MACEDONIA

2002 20072002 2007

- WHO CINDI Programme -- WHO CINDI Programme -

VERA SIMOVSKA, MD.,PhD.National coordinator of

the Programme for prevention and control of CVD and other NCD in FYR ofMacedonia, 2002-2007


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.




P R E F A C E

Necessity of well coordinated action aimed primarily to health promotion and primary

prevention of noncommunicable chronic diseases (NCD) such as: cardiovascular,

cerebrovascular and other circulatory diseases, diabetes, some types of carcinomas

and other NCD, leading according to morbidity, mortality, disability and the price of

health care in FYR of Macedonia imposed by larger investments by the Government

in realization of preventive measures and activities.

Giving support in preparation of coordinative activities and evaluation of interventions

aimed to prevention and control of the risk factors (RF) common for more of the NCDis of primal importance, such as this Draft-Plan of Action for realization of integrated

intervention programme in FYR of Macedonia.

The programme is focused on prevention and control of common risk factors (RF)

related by high prevalence of behavioural unhealthy lifestyle and envoronmentalfactors responsible for the appearance and development of the leading NCD such as

cardiovascular diseases (CVD), high important public health problem in the Republic.

The priority of the programme are settled on the base of the obtained results from the

clinical - epidemiologic researches of NCD, especially CVD and the problems

derived from the development of atherosclerosis in the past 10 years (1991-2001), as

well as on the base on data from the Reports of the regular vital statistics, published

by the State Institute of Statistics (1972-2001).

Besides this, the Draft - Action Plan is based on general information of the stateincluding geographic and climate conditions, demographic characteristics, social-

economic conditions, the health condition of the population, organization on the

health system and the reforms in the primary health care (PHC).

Fields of priority for action aimed to multiple reductions of morbidity and mortality

risk from NCD, according to the Action Plan are:

1.Cardiovascular diseases, especially ishaemic or coronary heart disease (CHD)(heard attack) as well as

2.Cerebrovascular (stroke) and other circulatory diseases

3.Integrated preventive interventions are aimed to those RF that can be modifiedand are common for several NCD and those are:


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- Behavioural (lifestyle) factors (unhealthy nutrition, sedentary lifestyle withreduced level of physical activity under the necessary minimum, smoking,

increased consumption of alcohol and psycho-social stress) and

- biological factors (obesity, increased level of serum cholesterol and

tryglycerids in the blood, hyperglycemia and hypertension)

Smoking, increased consumption of alcohol and psychosocial stress are research

subject of particular national prevention programs. In purpose to achieve an adequate

evaluation of morbidity risk from prevention-therapeutic aspect and preparation of a

chart of global risk in the Republic, those risk factors are included in CINDI

Programme (questionnaires of WHO CINDI Health Monitor survey).

According to the Draft-Plan of action this preventive interventions are implemented in

the community and primary health care (PHC) because of their more efficient use and

with a possibility for connection with the public health institutions.

Principal achievement from organizing and implementation of this Action plan is the

integration of these projects in the health system in the period between 2002 and 2007.

Action plan is the main component in the effort of realization the reforms in health

system in FYR of Macedonia. With integration of the prevention of CVD and other

NCD in the health politic and with the reforms in the health care, a corresponding

support of the government can be acquired.

Application of the National Protocolwill provide scientific information and evaluation

system, giving a contribution in the development of the health politics on national andregional level.

The Plan of action is drawn-up on the recommendations based on theoretical

consideration presented and on the result and expiriences in North Karelia and WHO

CINDI Protocol and Quidelines.

Such concerned preventive action should reduce not only cardiovascular, but also

other major NCD , with an overall improvement in health and lengh of life.

Community-based intervention programme combined media and other messages withbroad ranging community activities involving sectors such as: PHC, NGO, school and

worksites, food manifactures, local media etc. The essential component of CINDI

Macedonia Programme is the system of first-rate monitoring and evaluation.

16.08.2002 Vera Simovska,MD.,PhD. National coordinator

Programme for prevention and control of CVD and

other NCD in FYR of Macedonia

WHO CINDI Programme, 2002-2007


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PLAN OF ACTION, 2002-2007

C O N T E N T S

INTRODUCTION

First phase:Background1.1. Analysis of situation in FYR of Macedonia

a) General information for FYR of Macedonia

b) Administrative structure and planning in the health department(First two part are presented in the Supplement: Situation analysis)

c) Health conditions of the population (1972-2001)

- Mortality and morbidity of NCD and CVD

- Prevalence of biological (morph functional) and lifestyle (behavioral) risk factors

1.2. Problem statement1.3. Main assumptions

Second phase:Establishing a national coordinationA) Establishing a location of the CINDI coordinative center with an information base

B) Establishing an organization structure for implementation of the programme

C) Preparation of the conceptual model of the CINDI programme

Third phase: Finalization of the action plan

Fourth phase: Baseline survey CINDI Health Monitor(March-May, 2002) Development of the national recommendations and intervention

methods for reduction risk factors for CVD and other NCD

Fifth phase: Forming a national register for risk factors of CVD and NCDA) Results from the risk factor surveyon demonstration levelin 2002 and

periodical research on national level in 2004(CINDI Health Monitor)B) Forming a national register for risk factors of CVD and NCD in FYROM

Sixth phase:Initiation of preventive interventions for reduction of risk factorswhich are connected to the lifestyle of the population(1thsept.2002)

A) At community level and

B) primary health care (PHC)

Seventh phase:Evaluation of a five-year period (2002-2007)Eighth phase: Future development of the national programme


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II. GENERAL GOALS

III. AIMS OF THE PROGRAMME

MAIN OBJECTIVES:

- Initially- Development

INTERMEDIATE OBJECTIVES

NATIONAL OBJECTIVES

- Initially

- Development

IV. SPECIFIC GOALS

V. NECESSARY ACTIVITIES FOR REALIZATION OF THE PROGRAMMEFOR PREVENTION AND CONTROL OF CARDIOVASCULAR DISEASES

A. Preparation period 2002

B. Educational and organizational activities (2002-2003)

C. Practical orientation of the implementation of the programmeD. Principles of prevention and control of CVD and other NCD

(strategies and human resources)

1. Population strategy (universal)

.2 Selective or target prevention (high risk strategy)


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INTRODUCTION

First phase:Background

1.1. Analysis of situation in FYR of Macedonia

Health conditions of the population (1972-2001)

- Mortality and morbidity of NCD and CVD

Main NCD such as CVD, cancer, diabetes, obesity and respiratory diseases, now

account 59% of the 56.5 million deaths annually worldwide.

During the last decade in FYR of Macedonia, NCD are the major cause of death and

disability. Rapid social and economic changes togather with luck of clear policydirection and education reflects a significant change in lifestyle (unhealthy dietary

habits, reduced physical activity level, increased alcohol and tobacco use).

In 2001, one-third or 16.6 million of total global deaths are caused from the various

forms of circulatory diseases.

7.2 millions due to heart diseases and 5.5 to cerebrovascular disease. In addition, 3.9

million people die annually from hypertensive and other heart conditions.

Coronary heart disease (CHD) is the leading cause of death and other disability in themost developed countries. Other parts of the world have shown different patterns

including high rates of CVD mortality in eastern Europe that continue to rise and an

epidemic of CHD and stroke amarging in developing countries.

In Unated States, heard disease and stroke, the principal components of CVD,

accounted for 40% of all deaths in 2001, remain the first leading cause of death.

17% were aged


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Figure 1. Mortality rate from noncommunicable diseases in the FYR ofMacedonia for the period 1991-2001 up to 100.000 population

The mortality rate from CHD was 99.4/100.00 in 1991 and 120.9/100.000 in 1997

among the males and 68.1/100.000 in 1997 among the females.

The mortality rate from cerebrovascular diseases in males was 130.4/100.000 in the

beginning of the nineties and the trend was increased up to 163.2 in 1997. The samecondition was noticed in females.

There are important differences in cardiovascular deaths rate by region (Map 1) and

probably also by socioeconomic status and ethnicity despite data on this are very

scarce.

The causes of these disparities in CVD burden are primarily envirovmental and likely

include differences in CVD risk factors, lifestyle and the availability of preventive

services.

For examle: in 2001 the mortality rates from CVD are high in the next towns

(>50.000 inhabitans): Bitola, Veles, Prilep, Strumica and Kumanovo.

The mortality rates are at least in Tetovo and Gostivar (Map 2).

359,5385,9

464,9 468,6

108,3 111,4

129,5 140,5142,6 150,3

458,7464,9

0

50

100

150

200

250

300

350

400

450500

1991 1993 1995 1997 1999 2001

KVB

Cancer


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Map 1. Deaths by causes, FYR of Macedonia, 2000.

Map 2. The high mortality rate from CVD in FYR of Macedonia, 2001.in cities >50.000 inhabitans

3

4

5

472.7

529.6

659.5

544.0

472.9

405.437.


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The mortality rates were above the average mortality rate in the FYR of Macedonia

in the next 10 municipalities, in 2001: Berovo, Vinica, Resen, Kavadarci, Kocani,

Makedpnski Brod, Demir Hisar, Ohrid and Sveti Nikole.

The morbidityrate from CVD in the period of 1991-2000 has oscilated.In 2000, registered cases from CVD was 10.17% of total number of ambulatory-

policlinic cases in the Republic (from the registers in general practice, occupational

health, pediatrician and school-age children ambulatories).

18.7% of total number of registered cases from CVD was in the registry of general

practice doctors in 2000 (Figure 2).

Figure 2. Morbidity rate from circulatory diseases in FYR of Macedoniaup to 100.000 population.

The CHD and cerebrovascular diseases are in increasing trend, and the hypertension

morbidity rate was in the rank 6.000-10.000/100.000 (1972-1998).

Prevalence of biological (morph functional) and lifestyle (behavioral) risk factorsfor NCD and CVD in FYR of Macedonia

High prevalence of major biological risk factors such as high cholesterol, high blood

pressure, obesity and hyperglycemia as common risk factors, cause the majority of

chronic disease.

To reduce CVD mortality and morbidity first of all are needed global change in

lifestyle risk factors such as decreased physical activity level, unhealthy diet, smoking

and social stress by implementing the strategy of primary prevention and health

promotion.

0

5000

10000

15000

20000

25000

1972 1978 1984 1990 1991 1992 1993 1994 1995 1997 1998

Hypertensia

Ischemic h ard diseas e

Cerebro vas cular

Circulatory diseas es


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It,s the strategy theoretically of simple intervention adaption of a healthy lifestyle

with major impact in reducing the rates of NCD in relatively short time.

According to the results of two finished medical research in city of Skopje, the capital

of FYR of Macedonia (Minisrty of science and education, 1990-1998) there is high

prevalence of risk factors and among them some risk factors even grown in last 8

years. In randomized simples, 41.2% was overweight and obesity in 1998 and the

percentage was increased up to 58.3 in 2000 (Figure 3).

Figure 3. BMI Distribution in adult population in Skopje

in the last 10 years (1990-2000 year)

BMI distribution varies significantly according to the stage of transition of the

country. In the early stage of transition, it was estimated the tendency for rapidly

increase in the proportion of the population with high BMI than the proportion of

population with low BMI. In the later phase of transition, the distribution of BMI

tends to change again with increases in the prevalence of high BMI among poor.

16.7% have high blood pressure in 1998 (>160/95 mmHg) (Figure 4).

Figure 4. Prevalence of systolic and diastolic blood pressure in adult populationin Skopje (1990-1998)

75,865,5

58,8

41,6

14,915,9

18,2

41,5

9,3

18,623

16,8

0

10

20

30

40

50

60

70

80

BMI < 25 BMI > 25-29.9 BMI > 30

1990

1995

1998

2000

%

88,7

80,9

10

16,6

1,2 2,4

68,373,8

23,7

11,97,9

14,3

0

20

40

60

80

100

140 >160 90 >95

1990

1998

%


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High total serum cholesterol have 38% (>6.5mmol/L) and high LDL-cholesterol have

15.8% (>4.5 mmol/L) as part of population with high risk for CHD and heart attack.

35.2% are smokers and 35.9% have low cardiorespiratory fitness (VO2max-

ml/kg/min) or low physical activity level in 1998 (Figure 5).

Figure 5. Prevalence of risk factors for CVD and other NCD in adult

population from central region in Skopje (1990-1998)

Macedonian people have unhealthy diet habits because they don,t consume enough

fruit and vegetables. In 1999, vegetables intake has showed a slight increasing trend

from 152 gr/day in 1972 to 216gr/day as well as the fruit with annual quantities from

average 160 gr/day. The total intake, both for fruit and vegetable hasn,t reached the

recommendet daily intake of 400 gr./day min.

The average fat and oil intake is 47 gr/day in 1999. The use of animal fat is very slow

while vegetable (sunflower) oil mostly are mainly consumed.

1.2. Problem statement

Urgently are needed aggressive public health efforts and the national coordination to reduce

the CVD burden in FYR of Macedonia. At present, the role of Macedonian politicians in

giving support for development of NCD prevention at the community level is most

important.

For practical implementation of strategy for prevention of CVD, other NCD and

health promotion, some activities are required to be done in the first step:

28,2

75

2,5

23,418,2

12,5

3,7

35,235,9

18,215,8

28,8

23,8

14,2

0

20

40

60

80

T.Ch

ol>6

.5

T.Ch

ol>6

.5(B

MI>

25

TG>2

.3(B

MI>

25)

Gly

>6.5

LDL>

4.5

HDL


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Official politics in public health in the FYR of Macedonia:- formulation and implementation of political document in form of the

Government Resolution for Health until 2018 Public Health

Programme.

-

set-up of a strategy with determined goals and main directions for theMacedonian National Politic on Public Health in the next 15 years.

Official politics in area of NCD prevention in the country, focused onCVD prevention and control:

- public health programme need to be focused primary on prevention of

CVD, and other NCD and health promotion as main goals;

- formation of administrative structure presented in the Draft Plan of

Action for development and implementation of CINDI Programme in

the FYR of Macedonia, 2002 2007;

- appointment of key persons responsible for the National Programme by establishing a CINDI Centre for co-ordination of integrated approach

at community level.

To set-up the monitoring system CINDI Health Monitor:- public health, basic surveillance and analysis of behavioural and

biological factors of risk, common for several NCD using WHO

CINDI Health Monitor questionnaire (locally adapted).

New challenges and perspectives in field of CVD and other NCD

prevention and health promotion are:- building of co-operation, exchange of experiences and ideas on the

Balkan.

- co-operation between Balkan States i.e. South Eastern Europe countries

(SEE) with long term perspective which will lead to mutual interest.

1.3. Main assumptions

It was concluded that in FYR of Macedonia there are no registers on governmentallevel for cardiovascular diseases including coronary hearth disease, heart attacks of

the myocardium, neither registers for appoplectical insult (stroke).

There are no precise data for distribution of the key risk factors which are related to

NCD such as: hypertension, increased level of cholesterol and triglycerides in the

blood, smoking and the level of physical activity among the population.

Application of a standard questionnaire, periodically applied (every 2 to 5 years) or

following of those risk factors was never undertaken.

Evaluation of the risks on national level was never done.


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The information shown is a result of clinical-epidemiological research of aterogenic

risk factors done in 1990 and 1998. Particular surveys are done among specific

population groups and occupations (school children, adolescents, sportists), on regular

terms and on a national level.

National diet recommendation for treatment was never done.

Second phase: Establishing a national coordination

A. Establishing a location of the CINDI coordinative center with an information

base

B. Establishing an organization structure for implementation of the programme

C. Preparation of the conceptual part of the programme

A) Establishing a location of the CINDI coordinative center with an information base

1. Development, application, following and estimation of the complete intersector

activity in collaboration with the Ministry and the Government of the FYROM.

2. Foundation of a data base (CINDI Health Monitorsurvey) that obtains

information for prevention of NCD and CVD on a base of indicators, analysis

on data by application of software (SPSS) and connection with the central data

base of WHO/ EURO.

3. Establishing of national register of risk factors regarding appearance and

development of CVD and other NCD.

4. Pointing out priority aims of the programmed, application of strategies and

mechanisms for prevention of coronary diseases of the heart and some NCD.5. Monitoring and evaluation of methodology for the research of the risk factors

on the regional and local level.

6. Preparation of national reference and establishing intervention methods of the

risk factors regarding unhealthy lifestyle.

7. Preparation of national reference for future development of the progaramme.

8. Preparation of annual reports that will be distributed to the WHO Regional

Office of Europe

B) Establishing an organization structure for implementation of the program

In order to achieve greater efficiency and even more ration implementation of theprogramme activities, the territory of FYR of Macedonia is divided in 5 regions with

the following municipals and cities (Map 3): I Region- Skopje

II Region- West Macedonia: Ohrid, Struga, Gostivar, Kicevo and Debar III Region- Central and South Macedonia: Bitola, Prilep, Resen, Demir Hisar,

Mak. Brod, Krusevo, Kavadarci and Negotino

IV Region- Central and Southeastern Macedonia: Veles, Strumica, Stip, Radivis,

Sv. Nikole and Gevgelija V Region: Northeastern Macedonia: Kumanovo, Kriva Palanka, Probistip,

Kocani, Vinica, Delcevo and Berovo.


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Map 3. Organizational structure for implementation of the programmeCINDI HEALTH MONITOR CENTRES

General practice doctors in PHC in FYR of Macedonia, 2001.

Corresponding regional centers that belong to the territory to one region and have

more than 50.000 inhabitants are responsible for implementation of preventive

activities on communal level, aimed to reduction of the common risk factors related to

unhealthy way of living. The staff of the Primary Health Care Department will beresponsible for those activies.

C) Preparation of the conceptual model of the program (appendix)

Third phase: Finalization of the action plan

Fourth phase:Baseline survey CINDI Health Monitor(March-May 2002)

Development of the national recommendations and intervention

methods for reduction for risk factors of CVD and other NCDA) National dietary recommendations for treatment of hypercholesterolemia with

and without energetic restriction.

B) Recommendations for increasment of the level of individual programmed

physical activity in adults.

Fifth phase:Forming a national register for risk factors of CVD and NCDA) Results from the risk factors CINDI Health Monitor survey on

demonstration levelin 2002 and periodical research on national level in 2004.

B) Forming a national register for risk factors of CVD and NCD.

384

1877

167

150

133

199

149116

222


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Sixth phase:Initiation of preventive interventions for reduction of risk factors

which are connected to the lifestyle of the populationA) At community level and

B) Primary health care (PHC)

Seventh phase:Evaluation of a five-year period (2002-2007)

Eighth phase: Future development of the national program


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II. GENERAL GOALS:

Implementation of the WHO global strategy for cardiovascular and other

noncommunicable disease prevention and control in FYR of Macedonia through:

1. Stimulation of the global intersector collaboration in the field of

improvement of the health and the quality of life of the population and prevention of CVD and other NCD as a base for a development ofmultidisciplinary integrated communal level based approach.

2. Emphasize the role of the health workers

3. Improvement in the use of the existing resources for prevention of CVD and

NCD

4. Implementation of documented recommendations and methods

III. AIMS OF THE PROGRAMME in the FYR of MACEDONIA:

In the defining of main aims the priority is given to the leading NCD in FYR of

Macedonia determined by morbidity and mortality and their impact on the lifestyle.

MAIN OBJECTIVE:

Initially: To decrease the morbidity and mortality and invalidity due tocardiovascular disease for 5-10% in the following 5 years.

To decrease the premature mortality caused by the coronary heart

disease for 26% among population at the age from 45-64 in thefollowing 10 years.

Development: To reduce major chronic disease mortality, morbidity and

promote health.

INTERMEDIATE OBJECTIVES:

- Decrease the prevalence of main cardiovascular (atherogenic) risk factors :

elevated serum cholesterol, obesity and hyperglycaemia, elevated bloodpressure and smoking, at population level by introducing changes in the

lifestyle: increased physical activity, balanced diet and stoped tobacco use(primary prevention)

- improvement of the early detection and treatment (secondary prevention).

NATIONAL OBJECTIVES:

Initially: to be pilot for all FYR of MacedoniaDevelopment: to be demonstration and conceptual model program


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IV. SPECIFIC GOALS

A tendency for accomplishment of specific goals is a key of success according to

many national health authorities. Preventive interventions are aimed to common risk

factors and are procedure in PHC by communication with the community through themedia.

A) Diet intervention measures

1. Reduction of the total energy intake (kcal/d) that are originated from the

saturated fatty acid (SFA) including alcohol within the population from 15-

74 years old for at least 0.5% a year or 2.5% in the future 5 years.

2. Increasing the consumtion of fruits and vegetables for 25 % in the following

5 years by application of the food based dietary quidellines (FBDQ).

3. To decrease the number of persons at the age from 15-64 that add salt aftercooking by routine for 2% a year.

4. To reduce the number of persons with BMI of 25 kg/m2 and increased WHR

(>0.95 for man and >0.85 for women) at the age from 15-64 for an average

1% a year (or 5% in the next five years).

5. To increase the number of persons with a BMI of 30 kgm2 and increased

WHR at the age from 20-64 by implementation of hypocaloric diet in the

last 3 years, on PHC level for 5% a year, or 25% in the next 5 years.

B) Recommendations for increase of physical activities

1. Decrease the number of sedentary adults for 6 % until 2005.

2. Increase the number of adults that on a daily bases practice moderated physical

activity, >30minutes for 4% until 2005.

3. To increase the number of adults that train with an intensity that improves

cardiorespiratory fitness (VO2 max) according to recommendations of ACSM,

U.S. (1998), for 2% until 2005.

4. Increase the number of adolescents that practice moderated physical activity 5

days a week, for 2.5% until 2005.5. To increase the number of adolescents that train with an intensity that improves

cardiorespiratory fitness (VO2 max) according to recommendations of ACSM,

U.S. (1998) for 10% until 2007.

C) Decrease the number of smokers for 20% until 2007.

D) Decrease the average level of blood pressure for 10mmHg in the next 5 years.

E) Decrease the average level of cholesterol (mmol/L) for 10% until 2007.


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IV. NECESSARY ACTIVITIES FOR REALIZATION OF THE PROGRAMME

A) Preparation period - 2002

1. Analysis of the existing resource on regional/local level for involving of the

preventive activities in the five demonstration regions.

2. Establishing local preventive groups in PHC on community level, responsible

for the prevention of CVD and other NCD (net of units)

3. Establishing a corporation between PHC, local institutes for health care,

institutions for education, non-governmental organizations, private health

sector and the media in the five demonstration regions

B) Educational and organizational activities (2002-2003)

1. Education of health workers for practical applying of preventive intervention

aimed to unhealthy lifestyle: nutrition and physical activity (training of

educators in PHC).

2. Media activities (materials, massmedia, campaigns).

3. Establishing a net of detection and treatment of hypercholesterolemia: family

and groups of high risk.

4. Survay of prevalence and research of the major risk factors by implementation

of the programmed in PHC and building local information network i.e. system.

5. Envirovmental changes: smokefree areas, supermarkets, food industry etc.

C) Practical orientation of the implementation of the projects

The following projects in related to main risk factors are necessary :

- Activities for increase of the level of physical activity (PAL) of the macedonian

population (VO2 max / METT).

Preparation of the project in collaboration with the Agency for Youth and

Sports, Ministry of education and science and other relevant sectors in FYR ofMacedonia and collaboration with WHO/HQ working group for physical

activity Move for Health Initiative (2003)

- Activities for reduction ofbody weight. To prepare the project for the part

of population which is in vulnerability stage.

Organization of a mass media campaign Healthy weight for everyone (2003).

This project form a link between precede medical research and the applicationof new index as mathematical model for predicting the effects of non-

pharmacological interventions in the population at above/ average and high risk

for NCD such as truncal obese individuals with cardiovascular risk factors.


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Logistic model in form of equation is:

ln RR = 108.25881.7689 x DKN-B in +1.7087-BMI in+0.3993- Hbx 2.9423-

VO2max OPV10.5402x WHO in + 0.0770-50% kcal/h

Exponent B can be interpreted in terms of relative risk (RR) in cohort studies. The

proposed non- pharmacological intervention is hypocaloric, hiperprotein diets of

1200kcal/d and 1400 kcal/d (second phase) since the relative risk is less than 1

(lnRR


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The main point of activities at this type of strategy is aimed to measures, which lead to

improvement of health. During this, the health care institutions on a PHC level will

initiate certain actions regarding the national programme CINDI.

The PHC teams from each demonstration region will prepare a plan and a method for

health educational activities, will take part in organization and involving subjects in

the community as well as coordinate their work and evaluate the effects of the

performed activities, by establishing local information net.

Non-health sectors are of special significance in the accomplishment of his type of

strategy.

Population approach:

- Dietary changes to reduce blood cholesterol and blood pressure

-

Increasing level of physical activity- Smoking cessation

Selective or target prevention (high risk strategy) regarding:

- performing activities for identification of the population with high risk for

development of NCD,

- performing intervention measures for reducing or eliminating risk factors.

The preventive activities for reduction of NCD will be performed by all the subjects inthe health institutions, although the major part of the activities approximately 85% are

referred of PHC (global risk assessment/identification of high risk patients, health

education of the population), while the teams of the secondary health care will

intervene according to the necessity.

High risk approach:

- Hypertension

- Hypercholesterolemia

- Obesity

By gradually moving towards the measures of primary prevention (suspension or

delaying of NCD by manes or reduction or elimination of risk factors) including at the

same time activities for improvement of health, the great of necessity from secondary

prevention, which is extremely expensive, will also diminish.

The Action Plan is concerned with the implementation of population strategies for

altering the lifestyle and environmental characteristics, a high risk strategy for

bringing preventive care to individuals at special risk; and secondary prevention.


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Secondary prevention

Although special preventive and therapeutic measures are important for high risk and

sick individuals, respectively, they are of limited value as far as the control of

cardiovascular diseases at the community level is concerned.

Author:Vera Simovska, MD. PhD.

National coordinator of the WHO CINDI Programme in FYR of Macedonia.

Spec. of sports medicine

Subspec. of hygiene nutrition at healthy and sick people

16.08.2002 - I th submitting of the CINDI Action plan

to the Ministry of Health of FYR of Macedonia


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who cindi macedonian action plan, 2002-2007

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