WHO CINDI Health Monitor Survey in Macedonia

1
HEALTH MONITOR SURVEY - AN INTEGRATED PART
OF DEVELOPMENT CINDI CONCEPTUL MODEL IN THE
REPUBLIC MACEDONIA
National programme for prevention of
noncommunicable disease and health promotion in
the Republic of Macedonia, 2002 - 2007
National coordinator of the WHO CINDI, Univ.
Prof. Vera Simovska
WHO CINDI Programme Countrywide Integrated
Noncommunicable Disease Intervention Programme
2
Community and primary care-baseddemonstrati
on project for health promotion
andnoncommunicable diseases (NCD) prevention
hasbeen prepared as an integrated part of
conceptualmodel for CINDI National
Programme.
Republic of Macedonia is in the process
ofjoining CINDI and implementing the CINDI
conceptthrough the process of health care
reform.
In focus of the reform in primary health care
isthe implementation of health promotion and
NCDprevention measures in preventive
practice offamily doctors.
3
The purpose of the study
1. To analyse professional reasons that justify
realizationof the CINDI Programme based on
information of healthstatus in the Republic of
Macedonia.
2. Assessment of national capacity in primary
health careto realize CINDI project on promoting
healthy nutritionand physical activity in
different age groups.
3. The role of National Health Authority in
CINDI teamto confirm the Macedonian CINDI-Plan
of action inhealth promotion? heart disease and
other chronic diseaseprevention related to
physical activity and nutritionover the next 5
year (2002-2007).
4
M e t h o d s
1. Secondary data obtained from
mortality/morbiditystatistics in the Republic of
Macedonia (1990-2001).
The results for family aggregation of common risk
factorsfor chronic diseases obtained from
medical research such asBMI? Systolic/diastolic
BP? T. Chol.? TG? HDL? LDL? Glyc.?smoking?
decreased VO2max? dietary habit and stress in
randomized simples (Demonstation Projects 1990
and 1998).
2. National capacity in primary health care
obtained fromWHO questionnaire connected with
Assessment of nationalcapacity for
noncomunicable disease prevention controlin
2001 year.
3. Protocol and guidelines about CINDI
principles andstrategies for health promotion
and disease prevention (WHOCINDI publications).
5
R e s u l t s
1. NCD are the main cause of morbidity and
mortalityduring the last 10 years in the
Republic of Macedonia. ( Figures-1 and
Figure-2).
In the last three decades the cardiovascular
disease,especially coronary heart disease,
malignant neoplasm's,and diabetes mellitus
remains the most common cause ofdeath for the
Macedonian population.
In 1972 mortality from them accounting for 37
fromtotal mortality, and year by year this
percentage hasincreasing significantly up to
55.6 in 2001 with
continuous trend to this days.
6
Figure 1. Mortality rate from noncommunicable
diseases
in the Republic of Macedonia for the period
1991- 2001 up to 100.000 population
500
450
468.6
464.9
464.9 458.7
400
350
385.9
359.5
300
250
200
150
100
150.3
140.5 142.6
129.5
108.3 111.4
50
KVBCancer
0
1991 1993
1995
1997 1999
2001
7
Figure 2. Morbidity rate from circulatory
diseases in the Republic of Macedonia up to
100.000 population
Hypertensia
Ischemic hard diseaseCerebro vascular
25000
Circ u la to ry d is e a s e s
20000
15000
10000
5000
0
1972 1978
1984 1990 1991 1992
1993 1994 1995 1997 1998
8
The results for common risk factors
forNCD include
1. BMI distribution varies significantlyaccor
ding to the stage of transition of a
country.
Figure-3 illustrates the tendency for
rapidlyincrease in the proportion of the
populationwith high BMI than the
proportion of thepopulation with low BMI
in the early stage oftransition.
The distribution of BMI tends to changeagain
in the later phases of transition with
anincrease in the prevalence of high BMI
among
the poor.
9
Figure 3. BMI Distribution in adult population
in Skopje in the last 10 years (1990-2000
year)
1990

75.8
80
65.5 1995
58.8
70
1998
2000
60
41.6
41.5
50
40
23
18.2
18.6
30
15.9
16.8
14.9
9.3
20
10
0
BMI lt 25
BMI gt 25-29.9
BMI gt 30
10
Figure 4. Prevalence of systolic and diastolic
blood pressure in adult population in Skopje

88.7
100
1990
80.9
73.8 1998
68.3
80
60
40
23.7
16.6
11.9 14.3
7.9
20 10
1.2 2.4
0
lt140 gt140
gt160 lt90
gt90 gt95
diastolic BP
systolic BP
11
Figure 5. Prevalence of risk factors for
NCD in adult population from central region
in Skopje
80
75

60
40
35.9 35.2
28.8
28.2
23.8
23.4
18.2
20 14.2 18.2
15.8
12.5
3.7
2.5
0
1990
1998
12
2. There are great potential within primary
health care to realize CINDI project for health
promotion and the primary prevention of
major chronic diseases through changes of
lifestyle of the population such as increased
physical activity and balanced diet (average
1488 population per one MD).
The territory of the Republic of Macedonia is
divided into five regions with district
centres for the implementation of all NCD
related preventive activities (Figure 6).
13
Figure 6. Organizational structure -
CINDI HEALTH
MONITOR SURVEY CENTRES in the Republic of
Macedonia
167
1877
149
150
222
389
14
3. The role of the Macedonian Health
Authorityin CINDI team is to accept an
alternativeclassification system for
prevention strategies aimedat chronic
multi-factorial conditions.
This is based on three levels of
preventiondirected at everyone in the
population (public healthpromotion)? an
above/average risk groups (selectiveprevention)
and at high-risk individuals (targeted
prevention).
In this new scheme promotion and
preventionare used to describe those action that
occur beforethe full development of
the condition.
15
This project form a link between
precedemedical research and the application
of new indexas mathematical model
for predicting the effects
interventions in
the
of non-pharmacological
population at above/average and high
risk forNCD such as abdominal obese
individuals withatherogenic risk factors.
Logistic model in form of equation is
In RR 108.2588-1.7689 DKN-B in 1.7087 -
BMI
in0.3993- Hb 2.9423-VO2max OPV -
10.5402 WHO
in 0.0770-50 kcal/h
16
Exponent B can be interpreted in terms of
relative risk(RR) in cohort studies. The
proposed non-pharmacologicalintervention is
hypocaloric? hiperprotein diets
of1200kcal/d and1400kcal/d(second phase)
since the
relative risk is less than 1 (lnRRlt1).
Increased physical activity by the
recommendations of
ACSM (1993) and CDC
(2001)
statistically significant
promotes development of VO2max.
Change in level of VO2max at 17.16 from
baselinepromotes significant greater
reduction in level of WHR? WCsm? fat (F)?
body weight (BWkg)? LBM kg? BMR kcal/day
and LDL/HDL in PAD(physical activity and
diet) thanthose in D (diet) group obese
subjects
(Figure 7).
17
Figure 7. Change in level of VO2max and
major risk factors for NCD in FAD
(physical activity and diet) and D (diet) group
of abdominal obese subjects
25
VO2max
17,1HDL
14,8 15
10,4
5
WHR OS LDL/HDL
TT M LBM
FAI BMR
VO2-OPV
-1.8
-5
-3.1
-3,3 -3.3 -5.6
-5.3 -6.3
-4,5 -9,5
-5,2
-7,9 -10,3
-7.7 -9.3
-10,2
-15
-25
FADD
-28,6
-35
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CINDI PROGRAMME IN THE REPUBLIC OF MACEDONIA -
CONCEPTUAL MODEL
Ministry of Health
Coordination CINDI Centre
Administrative Sector
INTERVENTION PROCESSES
Used from health
Community level
Used from CINDI
Demonstartion area
population
services
randomized groups
programme
Secondvariables
First
Groups (gender and age) Location (schools, work)
-knowledge variables
-behaviour
-family
-cultural level
Inicial indicators
-social support
-community
1. Morpho-phisiological risk-factors
-organized
1. individual health status,
groups andindividuals
BMI WHRHTA mmHg
Final indicators
2. socio-demographic characteristics
1. risk factors
-screening of
Fc in rest/maxTot. cholest TGHDL2-holest
2. morbidity of major NCD
risk factorseducation/promotion
3. social enviroment
3. mortality
VO2 max./ METs.
CINDI Conceptual model
2. Behavioural risk
in Macedonia, 2002 2007.National coordinator
of the WHO CINDI Programme
factorsNutrition, Smoking and
MONITORING AND EVALUACION
Physical inactivity
Simovska Vera, MD,PhD.
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Conclusions
Monitoring of health behaviours and related
factors on a national level isan important
vehicle for health promotion and disease
prevention.
The overall purpose of the CINDI Health Monitor
is
- to evaluate and to promote favourable health
behaviours in population
- to evaluate the effectiveness of national
health policy.
The proposal-project to establish a CINDI
national health behaviour
monitoring system in the Republic of Macedonia
was created in 2002 yearas part of CINDI
conceptual model for development and
implementation ofNational programme for chronic
diseases prevention and health promotion(WHO
CINDI Programme).