1 / 55

Dr. Bela Shah Sr. Deputy Director General Division of Non-communicable Diseases

31 st Annual National Conference of IAPSM, Chandigarh 27-29 February 2004 Non Communicable Diseases Surveillance in India. Dr. Bela Shah Sr. Deputy Director General Division of Non-communicable Diseases Indian Council of Medical Research New Delhi.

thomasrodriguez
Download Presentation

Dr. Bela Shah Sr. Deputy Director General Division of Non-communicable Diseases

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 31st Annual National Conference of IAPSM, Chandigarh 27-29 February 2004Non Communicable Diseases Surveillance in India Dr. Bela Shah Sr. Deputy Director General Division of Non-communicable Diseases Indian Council of Medical Research New Delhi

  2. Deaths due to Non-communicable and Communicable diseases 1990-2020 India, and World (Males)

  3. ESTIMATED & PROJECTED MORTALITY RATE FOR CAUSES OF DEATH (PER 100,000) BY SEX, INDIA

  4. Mortality by cause in India-1990 & 1998NCDs emerging as major causes of mortality

  5. Burden of risk factors Smoking Prevalence by WHO Regions, 1998 World 1998: 1,235,000,000 smokers Estimate 2020: 1,670,000,000 smokers 43.8% 23.4% 34.2% 8.7% 62.3% 5.8% 34.7% 23.0% 48.2% 8.2% 36.2% 9.4% Male Female

  6. DALYS (‘000) FOR CARDIOVASCULAR DISEASES IN INDIA DURING 2000-2020 Source: The Global Burden of Disease by CJL Murray and AD Lopez, WHO 1996

  7. Attributable Mortality & DALYs by Overweight World Health Report 2002

  8. Rising Prevalence of Obesity in Urban India BMI >27 kg/m2 Gupta et al, IHJ 2002

  9. Surveillance needs for NCDs

  10. Surveillance needs for NCDs What is surveillance? Surveillance is the ongoing collection, analysis, and use of health data for the planning, implementation, and assessment of disease control "information for action”

  11. Surveillance needs for NCDs Uses of surveillance data • Identify extent of the problem • Map emerging patterns and trends • Measure progress in primary prevention • Contribute to policy making

  12. Surveillance - essential for health policy Health Information System MonitoringEvaluation of HP/DP Programmes Surveillance population measures NCD/MH/Injury Surveillance

  13. Strategy for NCD surveillance The causal chain Behavioral RF • Tobacco • Alcohol • Physical inactivity • Nutrition • Disease • Outcomes • Heart disease • Stroke • Diabetes • Cancer • Respiratory • Physiological RF • BMI • Blood pressure • Blood glucose • Cholesterol

  14. NCD Risk Factor Surveillance: Focus … selected risk factors associated with major NCDs and amenable to interventions. … simple surveillance systems. … standard definition and methods. … surveillance for primary prevention of NCDs.

  15. The WHO STEPS approach Rationale for selecting risk factors • Greatest impact on NCD mortality and morbidity; • Modifiable by intervention; • Validated measurement; • Meaningful comparisons possible; • Measurement can be obtained following ethical standards.

  16. Risk factors common to major noncommunicable conditions

  17. SOURCES OF SURVEILLANCE DATA COLLECTION FOR NCDs in India • Mortality Data • Medical Certificates for Death • Cause of Death Survey • Hospital Records • Morbidity data • Registry- Cancer • Special Surveys • Hospital Reports • Risk Factors • Special Surveys

  18. Current Surveillance Activities • Disease Control Programs • NPSP • HIV/AIDS • TB • Malaria • Leprosy • NPSCD (National Program for Surveillance of Communicable Diseases) • Other routine Surveillance Activities

  19. Ongoing regular periodic surveys Census of India NFHS-National Family Health Survey NSSO-National Sample Survey Organization

  20. Population Based Cancer Registries Mumbai Bangalore Chennai Delhi Bhopal Barshi (rural) Hospital Based Cancer Registries Thiruvananthapuram Dibrugarh Mumbai Bangalore Chennai Network of National Cancer Registry Programme

  21. Age-adjusted rate (per 100,000) All cancers, 1997

  22. Trends in Age standardized Cancer Incidence Rates among Menin India (1982 to 1994) 160 140 120 Age Standardized Incidence Rate 100 80 60 40 20 0 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 Bangalore Mumbai Chennai Delhi Bhopal Barshi

  23. National Cancer Registry Programme 1997

  24. Incident Cancer Cases in India

  25. Common Cancers among Men in India1997 according to Crude Incidence Rate

  26. Common Cancers among Women in India

  27. Development of Sentinel Health Monitoring Centres in IndiaAn ICMR-WHO Initiative

  28. Disease Surveillance • An Integrated Disease Surveillance System for the country has been a felt need for the country • It is expected to be the back bone of Public Health System in the country • Early identification of disease outbreaks & occurrence • Facilitating resource allocation • Monitoring disease control program

  29. Analyse this Marked Heterogeneity! Kerala High literacy rate, developed • Different • dietary • patterns Delhi Metropolitan city, highly urbanised, heterogeneous population • Different • body • composition Nested population Terrain, relatively underdeveloped Jammu & Kashmir • Different • habits Nested population Underdeveloped, Tribes and Terrain Nagaland Bihar Illiterate, Poor population Rural, Agricultural, Tribals

  30. GoalTo develop a sustainable system for NCD Surveillance in India Aim To set up Regional Sentinel Health Monitoring Centers for NCDs in India

  31. Following Six centers are carrying out the study, representing 5 Geographic Regions of India

  32. Risk Factors • Tobacco - Current, past, and never. Age of initiation • Smoking form and nonsmoking form (orally consumed and application forms). • Alcohol - regular, (age of initiation also) occasional, past, and never. Type of alcohol. Country liquor, IMFL. • Diet- consumption of fruits, vegetables, non-vegetarian food and oil/fat used. • Physical activity- type and degree • Measurements- Blood Pressure, Pulse rate, Waist circumference

  33. Core Expanded Optional Comprehensiveness The WHO STEPS approach The WHO STEPwise approach to Surveillance (STEPS) of NCD Risk Factors Step 3 Complexity Step 2 At each step Step 1

  34. The WHO STEPS approach Levels of Risk Factor Surveillance at each Step

  35. Sample Size

  36. BEHAVIOURAL RISK FACTORS “Actions/Behaviour that people engage in that put their health at risk” NCDs • Diseases of affluence • Diseases due to urbanization • Diseases of developed world • Chronic diseases Biobehavioural disorders

  37. HEALTHY WORKPLACESINDIAN EFFORTS 2001-2002 Surveillance of CVD risk factors in 10 major industries across India-Baseline Survey (in collaboration with CII, MoHFW and WHO) 2003-2004 Development and implementation of health interventions; surveillance of cause-specific mortality; event registries.

  38. EXTENSIVE BASELINE SURVEY FOR CVD RISK FACTOR AND DETERMINANTS 10 INDUSTRIES TWINNED WITH MEDICAL COLLEGES HEALTH EDUCATION AND PROMOTION COST-EFFECTIVE ALGORITHMS FOR IDENTIFICATION AND PREVENTION OF ACUTE AND CHRONIC CVD Further surveillance of CVD RF/Determinants for trends Ascertainment and Monitoring of CVD morbidity and mortality

  39. New Delhi Lucknow Ludhiana Pune Nagpur Dibrugarh Coimbatore Hyderabad Bangalore Trivandrum Chennai (affiliate center) Study Locations Coordinating Center: New Delhi Study Centers:

  40. Distribution of BMI in Industrial Population Sentinel Surveillance study BMI (kg/m2) Male Female • >23 58.9 63.5 • >25 34.7 43.3 • >27 16.7 26.7

  41. The Concept of IDSP • Decentralized • Integrated • Action oriented • Bring together both the communicable and non communicable diseases under one surveillance activity.

  42. Background of IDSP • World Bank funded project through MoH&FW • Surveillance of infectious and Non- communicable (NCD) diseases share common infrastructure, processes and personnel • A coordinated approach to data collection, analysis, interpretation and dissemination will facilitate planning and implementation of intervention programs.

  43. Organogram National Surveillance Committee * Chairperson: Secretary Health or Secretary Family Welfare (to alternate)

  44. Organogram State Surveillance Committee * Chairperson: State Secretary Health

  45. Aims of IDSP- NCD risk factor surveillance • Monitor trends of important risk factors of NCD in the community over a period of time • Evolve strategies for interventions of these risk factors so as to reduce the burden of diseases due to noncommunicable diseases • Strengthen NCD surveillance at District level 4. To integrate the NCD risk factor surveillance with IDSP 5. Evolve a data bank

  46. Partners • Ministry of Health & Family Welfare • ICMR • IndiaCLEN • World Bank • WHO • State & District level Surveillance Officers

  47. Characteristics of a surveillance system influence Research Surveillance Health Policies and programmes evaluate Information

  48. Suggested Strategies for NCD SURVEILLANCE in India • Integrated national surveillance programme • Include Comm. Disease and Selected NCDs/ Risk Factors • Identify populations for development of NCD Risk Factor surveillance module • Utilize medical schools/ students for implementation

  49. SUGGESTED STRATEGIES for NCD SURVEILLANCE in INDIA • Initiate National level control programmes • Establish govt. policies for programme implementation • Encourage surveillance for NCDs • Incorporate findings of surveillance into national programmes for Intervention

More Related