WHO-PACKAGE OF ESSENTIAL NCD INTERVENTION - SCHC EXPERIENCE Southern Community Health Center – Peleliu.2014

- Tukana Korovou

SOUTHERN COMMUNITY HEALTH CENTER -PELELIU

Southern Community Health Centre is located in Peleliu State.

the biggest island state of the southern Palauan archipelago.

manned by a medical officer, a nurse, a recorder and a maintenance officer.

world famous after World War II and currently features War Relics for tourists and visitors from around the globe.

2013 SCHC CENSUS : POPULATION

Ethnicity Females Males Total

Non Palauans

Asians 14 13 27

Europeans 1 3 4

Americans 0 2 2

Micronesians

0 2 2

Palauans

Palauans 193 212 405

 

Total 208

( 47.2%)

232 (52.7%)

440

8%

92%

Ethnic distribution of population in Peleliu :

2013

Non Palauans Palauans

2014 SCREENING

WHO – PEN (WHO- PACKAGE ESSENTIAL NCD INTERVENTION) Screening

PEN TOOLS USED

All the tools were provided by the NCD Unit.

SCHC staffs devised a questionnaire for the screening.

Charts indicate the 10-year risk of a fatal or non-fatal major cardiovascular event (myocardial infarction or stroke), according to age, gender, blood pressure, smoking status, total blood cholesterol and presence or absence of diabetes mellitus .

Risk levels

The color of the cell in the chart indicates the 10-year risk of combined myocardial infarction and Stroke risk (fatal and non-fatal) as shown below.

Green <10%

Yellow 10% to <20%

Orange 20% to <30%

Red 30% to <40%

Deep Red > 40%

WHO-PEN EXCLUSION CRITERIA:

Chart can not be used on participants with the following conditions:

1. Established CVD: previous history of myocardial infarction, previous coronary artery procedure(s), and stroke.

2. Without established CVD but have a total Cholesterol of > 320mg/dL.

3. Without established CVD with persistently raised blood pressure ( > 160-170/100-105 mm Hg)

4. With Type 1 or Type 2 DM with overt nephropathy or significant renal disease.

5. With renal failure or renal impairment.

NOTE:

With any of these conditions, the chart is not a good predictive tool of future cardiovascular event (CVD Risk).

 

WHO – PEN (WHO-package of essential NCD) Screening -Peleliu 2014

Started in March 18th 2014….. completed in June 2014.

Target was the age group between 40-70 years old; a total of 186 and is 42.3% of the population.

NATURE OF THE SCREENING

Enquiries in to risk factors/behaviors of participants; namely smoking, chewing betel nut with tobacco,alcohol,physical activities status.

Height and weight to determine BMI (body mass index)

Blood pressure taking

Blood sugar reading

Blood cholesterol reading

Urine tests

RESULT – PEN 2014 112 individuals participated in the screening

60.2% of the target population.

98% Palauans and 2% non-Palauans

57% participants were females and 43% were males.

AGE OF PARTICIPANTS

Age Ranges Female Male Total %age

26-39yrs 8 4 12 10.7

40-49yrs 19 19 38 33.9

50-59yrs 19 12 31 27.7

60-69yrs 12 11 23 20.5

>70yrs 6 2 8 7.1

Total 64 48 112 99.9

11%

34%

28%

21%

7%

Distribution of age groups of PEN partic-ipants in Peleliu 2014

26-39yrs 40-49yrs 50-59yrs 60-69yrs >70yrs

RESULT – 2014 SURVEY

Nationality Female Male Total

Bangladeshis 0 1 1

Filipinos 1 0 1

Palauans 63 47 110

Total 64 48 112

RESULT – 2014 SURVEY (CONT)

2%

98%

Ethnic distribution of PEN participants in

Peleliu 2014

Non-Palauans Palauans

57%

43%

Gender distribution of PEN participants in

Peleliu 2014

Females Males

MEDICAL HISTORY

Other Medical Conditions

Female Male Total %age

No medical conditions 40 35 75 66.9

Existing medical conditions

24 13 37 33

Total 64 48 112 99.9

67%

33%

Distribution of medical history of Peleliu PEN

participants :2014

No medical conditionsExisting medical conditions

REVIEW OF SYMPTOMS

Systemic review Female Male Totalangina, sob on exertion, increased thirst

0 1 1

Increase thirst,polyuria 8 2 10

Increased thirst 6 11 17

Loss of weight 5 1 6Loss of weight and increased thirst 2 0 2

Loss of weight, increased thirst 1 1 2

numbness of legs, weight loss ,increased thirst

1 0 1

REVIEW OF SYMPTOMS (cont)Systemic review Female Male TotalNumbness of limbs 1 2 3numbness of limbs, loss of weight, increased thirst

0 1 1

Numbness of limbs, weakness of limbs, weight loss

1 1 2

Numbness of limbs, weight loss, increased thirst,polyuria

0 1 1

Polyuria 2 6 8SOB & Increased thirst 1 0 1SOB on exertion, SOB on lying down, weight loss, increased thirst

1 0 1

Weakness of limbs & increase thirst

1 0 1

weakness of limbs, increased thirst,polyuria

1 0 1

REVIEW OF SYMPTOMS (cont)

Systemic review Female Male Totalweakness of lower limbs

0 1 1

weakness of limbs with loss of weight,polyuria

1 0 1

Weight loss 2 3 5

weight loss & increased thirst

2 2

weight loss & polyuria 3 1 4

Weight loss, increased thirst

1 1 2

weight loss, increased thirst,polyuria

2 3 5

Weight loss,polyuria,puffiness of face, swelling feet

1 1

Total 42 37 79

REVIEW OF SYMPTOMS

29%

71%

Systemic review of symptoms distribution of PEN participants in Peleliu 2014

No symptoms Existing symptoms

RISK FACTORS

Risk Factors Female Male Total

Drink alcohol 32 31 63

Chew betel nut with Tobacco 31 26 57

Smoke 5 13 18

No Physical activities 25 8 33

RISK FACTORS

37%

33%

11%

19%

Risk factors distri-bution of particiants

Drink alcoholChew with TobaccoSmokeNo Physical activities

Drink alcohol

Chew with Tobacco

Smoke

No Physical activities

0% 50% 100%

32

31

5

25

31

26

13

8

Risk factors distribution with in gender

Female Male

PHYSICAL EXAM

Positive physical examinations findings:

2 participants(1.8 % ) showed mild pedal edema

2 participants ( 1.8%) showed some cardiac lesions

4 participants (3.6%) had positive pulmonary findings

1 participant ( 0.89%) was paraplegic

BODY MASS INDEX (BMI)

Not all participants had their BMI calculated…exception was paraplegic participant who could not stand on the scale.

BODY MASS INDEXBMI Female Male Total %age

< 18.5

(underweight)

0 0 0 0

18.5 - < 25 (healthy weight) 15 8 23 20.5

25 - < 30 (overweight) 19 20 39 34.8

30 - < 40 (obese) 28 18 46 41.1

> 40 (very obese) 2 1 3 2.6

missing 0 1 1 0.9

Total 64 48 112 99.9%

BODY MASS INDEX

21%

35%

41%

3%1%

Body Mass Index distribution of PEN participants in Peleliu :2014

< 18.5 -underweight18.5 - < 25 - healthy weight25 - < 30 - overweight30 - < 40 - obese> 40 - very obesemissing

23/112 (20.5%) participants were in healthy BMI range.

88/112 (78.6%) participants had BMI in the overweight ,obese and very obese

categories.

BODY MASS INDEX BY GENDER

< 18.5 -underweight

18.5 - < 25 healthy weight

25 - < 30 overweight

30 - < 40 obese

> 40 very obese

missing

0 5 10 15 20 25 30

0

15

19

28

2

0

0

8

20

18

1

1

Distribution of gender BMI in PEN participants in Peleliu :2014

Male Female

More females have healthy BMIs than males.

More males were overweight than females.

More females were obese than males.

More females were very obese than males.

BLOOD CHOLESTEROL LEVELS (NORMAL LEVEL….<200mg/dL)

Blood cholesterol Females Males Total %age

<200mg/dL 31 22 53 46.9

>200mg/dL 34 26 60 53.1

Total 65 48 113 100

47%53%

Distribution of blood cholesterol levels of PEN participants in Peleliu

2014

<200mg/dL >200mg/dL

RANDOM BLOOD SUGAR

Random Blood Sugar Female Male Total %age

< 180mg/dL 57 46 103 92

> 180mg/dL 7 2 9 8

Total 64 48 112 100

RANDOM BLOOD SUGAR

92%

8%

Distribution of random blood sugars of PEN

participants in Peleliu:2014

< 180mg/dL > 180mg/dL < 180mg/dL > 180mg/dL0

20

40

60

80

100

120

57

7

46

2

Distribution of random blood sugars of PEN

participants in Peleliu:2014

MaleFemale

RANDOM BLOOD SUGAR- SUMMARY

103/112 (92%) of participants had RBS <180mg/dL.

9/112 (8%) of participants had RBS >180mg/dL

More females than males had RBS >180mg/dL

BLOOD PRESSURE

Blood Pressure (mmHg) Total %age

<101/65 1 0.9

101/65 - 140/80 ( normal ) 73 64.6

141/81 - 160/100 (high) 34 30.1

> 160/100 (very high) 5 4.4

Total 113 100%

1%

65%

30%

4%

Distribution of blood pressure of PEN participants in Peleliu : 2014

<101/65101/65 - 140/80 ( normal )141/81 - 160/100 (high)> 160/100 (very high)

BLOOD PRESSURE VS. BMI OF PEN PARTICIPANTS IN PELELIU - 2014

Blood Pressure ranges (mmHg)

BMI ranges Total

<101/65 (Low) 32 (obese) 1

101/65 - 140/80 (normal) 19.6 - 39 73

141/81 - 160/100 (high) 22 – 42.9 34

> 160/100 (very high) 28.8 - 39 5

BLOOD PRESSURE (NORMAL READINGS) VS BMI

Body Mass Index Female Male Total %age

<18.5 - underweight 0 0 0 0

18.5 – 25- normal 13 3 16 28.1

25 – 30 -overweight 12 7 19 33.3

30 – 40 -obese 16 6 22 38.6

> 40 – very obese 0 0 0 0

Total 41 16 57 100

28%

33%

39%

Distribution of BMIs of participants with normal BP readings in Peleliu

2014

<18.5 - underweight 18.5 – 25- normal 25 – 30 -overweight 30 – 40 -obese > 40 – very obese

HIGH BLOOD PRESSURE READINGS vs BMI

Body Mass Index Female Male Total %age

<18.5 underweight 0 0 0 0

18.5 – 25 (healthy weight )

1 0 1 4.5

25 – 30 (overweight) 1 7 8 36.4

30 – 40 (obese ) 5 6 11 50

> 40 (very obese) 2 0 2 9.1

Total 9 13 22 100

5%

36%

50%

9%

BMI of PEN participants with high blood pressure readings in Peleliu :

2014

<18.5 - underweight 18.5 – 25- healthy weight 25 – 30 -overweight 30 – 40 -obese > 40 – very obese

HIGH BLOOD PRESSURE READINGS vs BMI- SUMMARY

High Blood Pressure readings vs BMI- Summary

22/112 (19.6%) participants had high BP.

Common in males than females.

BMI findings

o 5% of participants had normal BMIo 36% were overweight.o 50% were obeseo 9% were very obese

VERY HIGH BP READINGS vs BMI

Body Mass Index Female Male Total %age

<18.5 - underweight 0 0 0 0

18.5 – 25- healthy weight 0 0 0 0

25 – 30 -overweight 2 0 2 40

30 – 40 -obese 2 1 3 60

> 40 – very obese 0 0 0 0

Total 4 1 5 100

40%

60%

BMI of PEN participants with very high BP in Peleliu :2014

<18.5 - underweight 18.5 – 25- healthy weight 25 – 30 -overweight 30 – 40 -obese > 40 – very obese

VERY HIGH BP VS BMI-SUMMARY

5/112 (4.4%) of participants had very high BP readings

BMIs were either overweight (60%) or obese (40%)-there were no BMIs showing underweight, normal weight or very obese

There were a lot of females than males who were overweight and obese with very high blood pressure.

CARDIOVASCULAR RISK LEVELS

WHO classification

< 10% - Low risk levels

10 - < 20% - Moderate risk level…monitor 6/12 -1yr

20 - >30% - HIGH RISK … monitor 3-6 months

CARDIOVASCULAR RISK LEVELS

CVS Risk Levels

Female Male Total %age

<10% 56 32 88 78.6

10 - <20% 2 11 13 11.6

20 - < 30% 3 2 5 4.5

30 - < 40% 1 2 3 2.7

Missing 2 1 3 2.7

Total 64 48 112 100.1

CARDIOVASCULAR RISK LEVELS

79%

12%

4%

3% 3%

Cardiovascular risk levels of PEN partici-

pants in Peleliu : 2014

<10% 10 - <20%20 - < 30% 30 - < 40%Missing

<10

%

10 -

<20

%

20 -

< 3

0%

30 -

< 4

0%

Missing

0%10%20%30%40%50%60%70%80%90%

100%

56

2

3

1

2

32

11

2

2

1

Cardiovascular risk levels of PEN participants in

Peleliu 2014

MaleFemale

RISK LEVEL VS AGE

Age groups <10% 10 -

<20%20 - < 30%

30 - < 40% Missing Total

26-39yrs 10 0 1 0 1 12

40-49yrs 36 1 0 1 0 38

50-59yrs 24 5 1 1 31

60-69yrs 14 5 2 1 1 23

>70yrs 4 2 1 0 1 8

Total 88 13 5 3 3 112

26-39yrs 40-49yrs 50-59yrs 60-69yrs >70yrs0

5

10

15

20

25

30

35

40

10

36

24

14

4

0 1

5 521 0 1 2 10 1 1 1 01 0 1 1

Distributionf risk levels of participants in their age

groups

<10% 10 - <20% 20 - < 30%30 - < 40% Missing

Age groups %age Mod to severe Risk Levels

26-39yrs 8.3

40-49yrs 5.6

50-59yrs 22.6

60-69yrs 34.7

>70yrs 37.5 26-39yrs

40-49yrs

50-59yrs

60-69yrs

>70yrs0

5

10

15

20

25

30

35

40

%age of Peleliu PEN participants Mod to severe Risk Levels in age

groups-2014

%age Mod to severe Risk Lev-els

CARDIOVASCULAR RISK LEVELS- SUMMARY

78% of participants had their risk levels <10%.

12% had their risk levels at 10% < 20%.

4% of participants had their risk levels at 20% - <30%.

3% had their risk levels at 30% - < 40%.

3% were accounted as missing because they were not considered as participants.

A lot of males were in the moderate to severe risk levels and vulnerable age groups ranging from 50years to > 70years.

REACTIONS FROM PARTICIPANTS

1. Will quit smoking…..2. Please show me how to quit smoking….3. I’m afraid….4. I’m glad…..5. How can I loose weight?6. What foods should I eat?7. I will start exercise now…

CHALLENGES

Behavior changes….smoking, alcohol use,diet,exercise and chewing betel nut with tobacco.

Supplies ---- Cholesterol strips to given the same status as glucose strips… easy to get for all health center levels.

POSITIVES FROM THE SCREENING

Known NCD cases show improvements in compliance to medications.

Individuals engaging in healthy behaviors eg walking as group/individuals

Individuals walking freely to HC for BP and weight checks.

WORKERS AT PELELIU’S PPUC ORGANIZING THEIR WEEKLY WALK

SUMMARY

WHO PEN Intervention is a very simple and effective tool in NCD risk prediction and management in Peleliu

BUT

with availability of ALL its components.

THANK YOU FOR LISTENING

SULANG