Achievements in NCD Surveillance English-speaking Caribbean

1. Dr. Glennis Andall-Brereton Caribbean Epidemiology Centre (CAREC/PAHO/WHO) Achievements in NCD Surveillance English-speaking Caribbean WHO-IUMSP International Seminar on the Public Health Aspects of NCDs Lausanne, Switzerland, August 10-18, 2010

2. Outline of Presentation • Introduction and background • Achievements in NCD and Risk Factor surveillance • Plans for the biennium (2010-2011)

3. Introduction and Background

4. CAREC Member Countries • CAREC provides epidemiological support to 21 Member Countries • English and Dutch speaking • Bermuda in the North to Suriname in the South • Varying population sizes • Montserrat, 4,681 – Jamaica, 2,600,723 • Countries have well developed primary health care systems, secondary care services and some tertiary care services mainly in larger countries

7. Leading Causes of Death in CARICOM Countries by Sex, 2004 MALES FEMALES • Heart Disease • Cancers • Injuries and violence • Stroke • Diabetes • HIV/AIDS • Hypertension • Influenza/pneumonia • Heart Disease • Cancers • Diabetes • Stroke • Hypertension • HIV/AIDS • Influenza/pneumonia • Injuries and violence

8. Recommendation of CAREC’s Scientific Advisory Committee – 2002 Report of Caribbean Commission on Health and Development - 2006 Prime Ministerial Summit on NCDs - 2007 Declaration of Port of Spain, “That we will establish, as a matter of urgency, the programmes necessary for research and surveillance of the risk factors for NCDs with the support of our Universities and the Caribbean Epidemiology Centre/Pan American Health Organization (CAREC/PAHO);” Recognizing the Problem & Commitment to the surveillance of NCDs

9. Achievements in NCD and Risk Factor Surveillance

10. Development of Regional NCD Minimum Data Set Background • 2003 • CAREC NCD Minimum Data Set Developed and Agreed (Epidemiologists Meeting) • 2006 • Regional Strategy and Plan on Action for Chronic Disease for the Americas approved • PAHO HQ agreed to use NCD Minimum Data Set developed by CAREC as starting point for developing NCD Minimum Data Set for Americas • 2007 • PAHO Inter-programmatic Chronic Disease Surveillance Working Group established • Representation from countries in the Americas • Agencies: PAHO, WHO, CAREC, PHAC,CDC • (March 2007- June 2008) – NCD Minimum Data Set developed for the Region of the Americas • Stepwise approach - core, expanded and optional

11. Declaration of Port of Spain • Prime Ministerial Summit on NCDs - 2007 • Declaration of Port of Spain • “That we will establish, as a matter of urgency, the programmes necessary for research and surveillance of the risk factors for NCDs with the support of our Universities and the Caribbean Epidemiology Centre/Pan American Health Organization (CAREC/PAHO);”

12. Minimum Data Set for NCD SurveillanceComponents • Mortality from/with selected NCDs (12 core indicators) • Age-standardized mortality rates per 100,000 population • PYLL (potential years of life lost) per 100,000 • Prevalence/incidence selected conditions (6 core indicators) • Risk factors for chronic diseases : • Adult ( 17 core indicators) & Youth (8 core indicators) • Health System Performance Indicators (19 indicators - 9 core) • Socioeconomic and context indicators (16 indicators – 5 core)

13. Implementing NCD Minimum Data Set in the Caribbean • August 2008 - Training to Pilot NCD Minimum Data Set • Bahamas, Barbados, Belize, Bermuda, Cayman Islands and Dominica • March 2009 - Meeting for Evaluation of the Pilot • March-September 2009 – Revision of NCD Minimum Data Set based on outcome of Pilot • October 2009 – Training for the Implementation of the Minimum Data Set in CAREC Member Countries • 18 countries participated (Epidemiologists & NCD Focal Point) • Agreed start date for annual country reporting on NCD Minimum Data Set to CAREC: May 2010

14. Status of Country Reporting on Regional NCD Minimum Data Set • Reports submitted to date: • 7 countries: BVI, Barbados, Bermuda, Dominica, St. Lucia, St. Kitts and Nevis, St. Vincent and the Grenadines • Missing data • Additional time requested for reporting: • 5 countries: Aruba, Bahamas, Belize, Jamaica, Montserrat, Suriname • No reports or contact with CAREC • Anguilla, Antigua, Cayman Islands, Curacao, Grenada, Guyana, Trinidad and Tobago, Turks and Caicos Islands

15. Implementing Risk Factor SurveillanceUsing STEPS Methodology

16. The Survey MethodologyPan Am STEPS • Standardized system for surveillance of chronic disease risk factors • Designed for implementation in low and middle income countries • Assesses biological and behavioural risk factors • Flexible : Allows different levels of assessment of risks • STEP 1 Questionnaire • STEP2 Physical measurements • STEP 3 Biochemical measurements • Core, Expanded and Optional Modules • Individual randomly selected for interview at the household level

17. Implementing Risk Factor Surveillance • 6 countries have completed National Risk Factor Surveys using the Pan Am STEPS methodology as a starting point for surveillance of RFs for chronic diseases: • 2005 Bahamas • 2007 Aruba • 2008 Barbados, Dominica, St. Kitts • 2009 British Virgin Islands • First country to use Electronic Methodology (E-STEPS)

18. Prevalence of Overweight Persons (BMI ≥25 kg/m2) by Gender

19. Comparison of Physical Activity and Overweight

20. Comparison of the Prevalence of Current Drinkers and of Binge Drinking (harmful useof alcohol)

21. Mean Daily Servings of Fruits and Vegetables

22. Risk for Development of Chronic Diseases Raised Risk ≥ 3 risk factors

23. Implementing Risk Factor Surveillance contd.. • Two other countries completed National RF surveys using different methodologies and questionnaires • Jamaica (2001 & 2008) Lifestyle Survey-Tropical Medicine Research Inst. • Belize (2007) CAMDI Project

24. Implementing Risk Factor Surveillance in the Caribbean contd.. • Ten (10) other countries trained in implementing RF surveys using Pan Am STEPS methodology and involved at various stages of the planning process • Anguilla • Bermuda • Curacao • Grenada (fieldwork 2010) • Guyana • Nevis (Part of the Federation of St. Kitts and Nevis) • St. Lucia • St. Vincent and the Grenadines • Suriname • Trinidad and Tobago (fieldwork 2010) • Turks and Caicos Islands • 2nd National RF Survey • Bahamas (fieldwork 2010)

25. Providing Feedback on CD & NCD Surveillance in the Caribbean • Developing and implementing an Integrated Surveillance System at CAREC • Infobase • Caribbean CHARTS • Being developed in collaboration with the PAHO Health Information Platform (PHIP) to facilitate: • Country use of CD & NCD information for planning and programming • Sub-Regional Reporting on POS Declaration • Advocacy

26. Outputs of Integrated Surveillance System (NCD and CD) • Country profiles • Sub-Regional profiles • Age-specific profiles • Disease profiles • Maps • Ad-hoc queries

27. Chronic Disease Profile

28. Plans for 2010-2011 • Continue technical support to countries: • Reporting on NCD Minimum Data Set • Implementing risk factor surveillance • Development and implementation of routine data collection on limited number of morbidity indicators for chronic disease • e g. amputations, incident heart attacks, retinopathy • Revision of Country Surveillance Manuals to include indicators on NCDs along with CD indicators.

29. Plans for 2010-2011 contd…. • Develop and implement multimode approach to risk factor surveillance to accomplish continuous surveillance of risk factors • Addition of few selected risk factor indicators to routine country surveys eg. Labour Force Surveys, National census • Addition of selected risk factor indicators to routine primary health care data collection e.g., clinic registration information, patient record cards • Collection of risk factor data on segments of the population e.g. use of telephone interviews etc. • Provide technical support to encourage/strengthen use of Disease Registries • Develop and implement proposals for conducting research in the area of cervical cancer prevention and control

30. Thank You for Your Kind Attention