ncd survll dr shah

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31st Annual National Conference of IAPSM, Chandigarh 27-29 February 2004 Non Communicable Diseases Surveillance in India: 

31st 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

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

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

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

ESTIMATED andamp; PROJECTED MORTALITY RATE FOR CAUSES OF DEATH (PER 100,000) BY SEX, INDIA

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

Mortality by cause in India-1990 andamp; 1998 NCDs emerging as major causes of mortality

Slide5: 

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

Slide6: 


DALYS (‘000) FOR CARDIOVASCULAR DISEASES IN INDIA DURING 2000-2020: 

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

Attributable Mortality & DALYs by Overweight: 

Attributable Mortality andamp; DALYs by Overweight World Health Report 2002

Rising Prevalence of Obesity in Urban India: 

Rising Prevalence of Obesity in Urban India BMI andgt;27 kg/m2 Gupta et al, IHJ 2002

Slide10: 

Surveillance needs for NCDs

Slide11: 

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' Surveillance needs for NCDs

Slide12: 

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

Surveillance - essential for health policy: 

Surveillance - essential for health policy NCD/MH/Injury Surveillance Monitoring Evaluation of HP/DP Programmes Health Information System Surveillance population measures

Slide14: 

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

Slide15: 

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

Slide16: 

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. The WHO STEPS approach

Risk factors common to major noncommunicable conditions : 

Risk factors common to major noncommunicable conditions

SOURCES OF SURVEILLANCE DATA COLLECTION FOR NCDs in India: 

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

Slide19: 

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

Slide20: 

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

Network of National Cancer Registry Programme: 

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

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

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

Slide23: 

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

Slide24: 

National Cancer Registry Programme 1997

Incident Cancer Cases in India: 

Incident Cancer Cases in India

Common Cancers among Men in India1997 according to Crude Incidence Rate: 

Common Cancers among Men in India 1997 according to Crude Incidence Rate

Common Cancers among Women in India: 

Common Cancers among Women in India

Development of Sentinel Health Monitoring Centres in India An ICMR-WHO Initiative: 

Development of Sentinel Health Monitoring Centres in India An ICMR-WHO Initiative

Disease Surveillance: 

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 andamp; occurrence Facilitating resource allocation Monitoring disease control program

Analyse this Marked Heterogeneity!: 

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

Slide31: 

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

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

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

Slide33: 

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

Slide34: 

Step 3 Complexity Step 2 Step 1 The WHO STEPwise approach to Surveillance (STEPS) of NCD Risk Factors At each step The WHO STEPS approach

Slide35: 

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

Slide36: 

Sample Size

BEHAVIOURAL RISK FACTORS: 

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

HEALTHY WORKPLACESINDIAN EFFORTS: 

HEALTHY WORKPLACES INDIAN 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.

Slide39: 


Study Locations: 

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

Distribution of BMI in Industrial Population Sentinel Surveillance study: 

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

The Concept of IDSP: 

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

Background of IDSP: 

Background of IDSP World Bank funded project through MoHandamp;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.

Slide44: 

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

Slide45: 

* Chairperson: State Secretary Health Organogram State Surveillance Committee

Aims of IDSP- NCD risk factor surveillance: 

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

Partners : 

Partners Ministry of Health andamp; Family Welfare ICMR IndiaCLEN World Bank WHO State andamp; District level Surveillance Officers

Characteristics of a surveillance system: 

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

Suggested Strategies for NCD SURVEILLANCE in India: 

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

SUGGESTED STRATEGIES for NCD SURVEILLANCE in INDIA: 

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

USERS OF SURVEILLANCE DATA: 

USERS OF SURVEILLANCE DATA Policy Makers andamp; Programme implementors Researchers and Public Health specialists Collateral agencies- food manufacturers, sports equipment,tobacco industry Public, Media Associations, Universities Donors, private medical services

Slide52: 

Key messages Recognize the emerging epidemic Effective interventions exist Partnerships to implement existing knowledge Set surveillance systems in place now, focus on risk factors Use a stepwise approach Link to policy and planning

Current status of implementation of NCD prevention and control programmes in SEAR Countries: 

Current status of implementation of NCD prevention and control programmes in SEAR Countries Note: Shaded areas indicate existence of a plan and the year of implemenation Source:Non-Communicable Diseases in South-East Asia Region, A Profile, WHO, 2002

Slide54: 

Source of NCD related data on the member countries in the region  

Prevention and management of NCDs: 

Prevention and management of NCDs Generating a local information base for action Establishing a programme for promotion of health across life span Tackling issues outside the health sector which influence prevention and control of NCDs Ensuring that health sector reforms are responsive to the challenge