Present NCDI situation in Present NCDI situation in MongoliaMongolia

Kh.Altaisaikhan /Professor of Medicine, Vice president of HSUM/

Mongolian step survey on non-Mongolian step survey on non-communicable disease risk factors communicable disease risk factors

2006 2006

Mongolian step survey on non-Mongolian step survey on non-communicable disease risk factors 2006 communicable disease risk factors 2006

The Mongolian NCD – STEPs survey is a nationwide cross–sectional survey, carried out throughout Mongolia in 2005.

The goal of the survey was to determine the prevalence of major NCD risk factors and to establish the baseline information for the surveillance of NCDs prevention and control.

The survey was conducted through three subsequent steps with the concept of the WHO Stepwise approach for NCD surveillance and data obtained from 3411 participants aged 15-64 years.

Mongolian step survey on non-Mongolian step survey on non-communicable disease risk factors 2006 communicable disease risk factors 2006

Step 1Step 1 Questionnaire

methodStep 2Step 2

Physiological measurements

Step 3Step 3 Laboratory

analysis

Survey results: Behavioral risk factorsSurvey results: Behavioral risk factors

1. Tobacco use1. Tobacco use

1. The prevalence of daily smokers was 24.2 % of the surveyed population aged 15 - 64 years.

2. There was a marked gender difference noted in the prevalence of daily smokers. The proportion of daily smokers in males (43.1%) were higher by 10 times as compared to that of females (4.1%).

3. An average age of initiation to smoking was 20 years.

Survey results: Behavioral risk factorsSurvey results: Behavioral risk factors

2. Alcohol consumption2. Alcohol consumption

1. 30.2% of the surveyed population aged 15-64 years consumed alcoholic beverages on a regular basis in the past 30 days; and in terms of gender, 44% of the surveyed male respondents and 15% of the surveyed female respondents consumed alcoholic beverages on a regular basis.

2. In the past 30 days, 2.2% of the surveyed population who consumed alcohol on a regular basis were drinking alcohol on 4 and more days a week thus presenting to be at high risk; and in regard to gender, 2.5% of male regular drinkers and 1.2% of female regular drinkers were at high risk.

3. There was a gender difference in alcohol consumption. The proportion of alcohol consumption on a regular basis and binge drinking were 3 times higher in males as compared to females.

Survey results: Behavioral risk factorsSurvey results: Behavioral risk factors

3. Fruit and vegetable intake3. Fruit and vegetable intake

Survey results: Behavioral risk factorsSurvey results: Behavioral risk factors

4. Physical inactivity4. Physical inactivity

Survey results: Health indicatorsSurvey results: Health indicators

1. Overweight and obesity1. Overweight and obesity

Survey results: Health indicatorsSurvey results: Health indicators

2. Diabetes mellitus2. Diabetes mellitus1. Prevalence of diabetes was 9.3% and this proportion was much higher as

compared to 3.1% of the data from the survey conducted in 1999.2. A proportion of impaired fasting glucose was found in 10.3% and there

was no remarkable difference compared to the prevalence of 9.2% in 1999.

Survey results: Health indicatorsSurvey results: Health indicators

3. Hypertension and blood pressure3. Hypertension and blood pressure

The prevalence of hypertension 28.1 (+0.1)%. With increased age the prevalence of hypertension was higher in

both sexes.

Survey results: ConclusionSurvey results: Conclusion

Smoking 27.6% Alcochol in moderate use 5% Current use of alcochol 0.7 % Unhealthy diet 72.5% Physical inactivity 23.1%

Hypertension 28.1% Diabetes 8.2% Obesity 9.8%

Survey results: ConclusionSurvey results: Conclusion

• 9 in every 10 people (90.6% of the surveyed population) had at least one risk factor for developing NCDs.

• One in every five people (20.7% of the surveyed population) had three or more risk factors or were at HIGH risk and in particular,

• One in every two males aged 45 years and above were at high risk in developing NCDs.

National programme on prevention National programme on prevention and control of non-communicable and control of non-communicable

diseasedisease

National programme on prevention and National programme on prevention and control of non-communicable diseasecontrol of non-communicable disease

1. Goal 1. Goal Reduce deaths caused by major NCDs through improving control and surveillance of NCDs and their risk factors and through effective health promotion action

The program will be implemented in two stages splitting into stage one as to be implemented during 2006-2009 and two as for 2010-2013

National programme on prevention and National programme on prevention and control of non-communicable diseasecontrol of non-communicable disease

1.1. Objectives Objectives Objective 1. To create sustainable mechanism for

coordination on prevention and control of major NCDs such as cardiovascular diseases, cancer and diabetes mellitus

Objective 2. To reduce risk factors of major NCDs by promoting healthy lifestyles and supportive environment

Objective 3. To make reorientation of health services (towards community-based, appropriate, accessible and effective) for major NCD-s

Non-communicable disease related Non-communicable disease related our experienceour experience

Non-communicable disease related Non-communicable disease related our experienceour experience

National survey on diabetes prevalence /2002/ Diabet Med. 2002 June;19 (6):502-8

Mongolian NCD STEPS risk factors survey /2005/ Development of national program on NCD prevention and

control /2005/ WHO Local fellowship on NCD prevention and control for primary

health workers NCD Regional Center establishment /2005/ (Khovd, Uvurkhangai,

Dornod) Essential emergency surgical care WHO Local fellowship WHO

Local fellowship training on primary health care Distance learning training program for primary health providers

The Diabetes Center in Ulaanbaatar, 2005

The Diabetes Center in Erdenet, 2005

New diabetes center was established with 3 rooms at out-patient clinic in Erdenet cities Central Hospital with necessary equipments

World Diabetes Day since 2001

Diabetes Educator Training May 2005

31 Mongolian health professionals were certified as Diabetes Educators

The incidence of diabetes in Mongolia

Global strategy of non-Global strategy of non-communicable disease prevention communicable disease prevention

and controland control

Noncommunicable Diseases 4 Diseases, 4 Modifiable Shared Risk Factors

TobaccoUse

Unhealthy diets

Physical Inactivity

HarmfulUse of Alcohol

Cardio-vascular

Diabetes

Cancer

ChronicRespiratory

Total deaths around the world:58 million

Total deaths around the world:58 million

Deaths from noncommunicable diseases around the world:35 million

Total deaths around the world:58 million

Deaths from noncommunicable diseases around the world:35 million

Deaths from noncommunicable diseases in developing countries:28 million

Total deaths around the world:58 million

Deaths from noncommunicable diseases around the world:35 million

Deaths from noncommunicable diseases in developing countries:28 million

Deaths from noncommunicable diseases in developing countries which could have been prevented: an estimated14 million

Noncommunicable Diseases Mortality among men and women aged 15-59 years (2004)

0

5

10

15

20

25

30

2004 2015 2030 2004 2015 2030 2004 2015 2030

De

ath

s (

mill

ion

s)

High income Middle income Low income

HIV, TB, malaria

Other infectious

Mat//peri/nutritional

CVD

Cancers

Other NCD

Road traffic accidentsOther unintentionalIntentional injuries

Noncommunicable Diseases Projected Deaths in 2015 and 2030

AFR EMR EURSEAR WPR AMR

Noncommunicableconditions

InjuriesInjuries

25

50

75%

WPRO Pattern of Morbidity is Similar to EURO and AMRODistribution of DALYS, by broad cause group and WHO Region, 1999

DALY = Disability-Adjusted Life YearSource: World Health Report, 1999

Communicable diseases, maternal and perinatal conditions and nutritional deficiencies

1. Integrating NCD prevention into the development agenda, and into policies across all government departments

2. Establishing and strengthening national policies and programmes

3. Reducing and preventing risk factors 4. Prioritizing research on prevention and health

care5. Strengthening partnerships6. Monitoring NCD trends and assessing progress

made at country level

Under each of the 6 objectives, there are sets of actions for member states, WHO Secretariat and international partners

Noncommunicable DiseasesGlobal Action Plan 2008-2013: Six Objectives

Promote results-oriented collaborative efforts

Scale up by pooling limited resources

Engage partners outside the health sector

Consolidate fragmented efforts

Noncommunicable DiseasesWhy working in partnership?

Mission: Help implement the NCD Action Plan by catalyzing an multi-sectoral, multi-level response, with a particular focus on developing countries

Goals: • Increase focus on NCD prevention and control through collective advocacy

• Increase resource availability (both financial and human capital)

• Catalyze effective multi-stakeholder action with a focus on country-level implementation

Noncommunicable DiseasesGlobal NCD Network

Stakeholders outside the health sector:• Ministries of Finance, Trade, Education, Social Affairs• Development donors (e.g. Austrian Development Agency, Ministry of Foreign Affairs)• International Financial Institutions • Intergovernmental Organizations• Private sector

Stakeholders from the disease and risk factor community:

Noncommunicable DiseasesGlobal NCD Network: Stakeholders

Working Group

Working Group

Working Group

Working Group

Funding Mechanisms

Funding Mechanisms

Global/Regional Forum MeetingsGlobal/Regional Forum Meetings

Implemented in 2009Implemented in 2009

Implemented in 2010Implemented in 2010

International Advisory CouncilInternational Advisory Council

WHO

Staff

Noncommunicable DiseasesGlobal NCD Network: Structure

Working Group

Working Group

Core competencies for caring for patients with chronic conditions

1. Patient-centred care2. Partnering3. Quality improvement4. Information and communication

technology5. Public health perspective

1. Patient-centred care

• Interviewing and communicating effectively

• Assisting changes in health-related behaviors

• Supporting self-management • Using a proactive approach

1. Patient-centred care

5 as approach:1. Assess2. Advice3. Agree4. Assist5. Arrange

Interviewing and communicating effectively

1. Patient-centred careSupporting self-management

2. Partnering

• Partnering with patients

• Partnering with other providers

• Partnering with communities

3. Quality improvement

• Measuring care delivery and outcomes

• Learning and adapting to change

• Translating evidence into practice

4. Information and communication technology

• Designing and using patient registries

• Using computer technologies

• Communicating with partners

5. Public health perspective• Providing

population-based care

• Systems thinking • Working across

the care continuum

• Working in primary health care-led systems

Partnerships, CollaborationPartnerships, Collaboration

• NGOs• CCs• UN agencies