national ncd program in oman
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Ministry of HealthOman
National NCD Program in Oman
Dr. Ali Jaffer MohammedAdvisor Health Affairs MOH
1
Ministry of HealthOman
Presentation Overview
• Five Year Plans
• NCD’s Burden in Oman
• Diabetes as an example
• Program Implementation
-National Level
-District Hospital level
-PHC level
-Community Level 2
Ministry of HealthOman
The Five year Plans
3 8th Five year plan 2011-20157th Five Year Plan 2006-2010
Ministry of HealthOman
Five Year Plan -Domain 13:NCD’s 7th Five Year Plan 2006-2010 8th Five year plan 2011-2015
4
Ministry of HealthOman
Scope & Rational• High Prevalence of NCDs in Oman (Ages
20+ years): Behavioral/individual Risk factors
• Diabetes 12%• Hypertension 35%• Dyslipidaemia 40%• Overweight & obesity 48%• Tobacco use 23%
14.7%Source: OWHS-2008 (2008) (2011)
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Ministry of HealthOman
Atherosclerosis, cardiovascular diseaseAtherosclerosis, cardiovascular disease
Central/abdominal obesity 24.6%
High FPG 18.1%
HBP 23.1%
MicroalbuminuriaHigh TG 20.7%
Prevalence of metabolic syndrome
Oman 21%USA23%
Endothelial dysfunction
Insulin Resistance Syndrome (Metabolic Syndrome)
Low HDL 75.4%
Source: Nizwa 2001 6
Ministry of HealthOman
Deaths attributable to diseases and injuries, all ages, Oman, 2002.
Source :WHO Global Burden of Disease 2002.
Total Deaths attributable to NCDs =62%
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Ministry of HealthOman
Disability-adjusted life years lost attributable to diseases and injuries, all ages, Oman, 2002.
Source: WHO Global Burden of Disease 2002
Total DALYs lost attributable to NCDs=23%
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Ministry of HealthOman
RationalIn the WHO Global Action Plan for Prevention
and Control of NCD objective # 3 is
So the Oman NCD prevention and control program is carrying out the activities at different health care levels
To promote interventions to reduce the main shared modifiable risk factors for non-communicable diseases : tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol.
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Ministry of HealthOman
The Top 10s (prevalence %) Till 2010 Oman was ranked in top 10, but in 2011 when the
International Diabetes Federation(IDF) recalculated the prevalence using different criteria, it has become 43rd Rank with a 10.75%
prevalence
(
IDF Atlas, V5, 2011
8th
43rd 10.7543. Oman
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Ministry of HealthOman
Country/territory Comp. prevalence (%) WHO Standard
Kuwait 21.10
Lebanon 20.17
Qatar 20.17
Saudi Arabia 20.02
Bahrain 19.88
UAE 19.22
Egypt 16.94
Libyan 14.19
Jordan 12.37
Iran 11.34
Oman 10.75
IDF Atlas, V5, 2011
6th
To
11th 11
Ministry of HealthOman
Annual and Cummulative Number of People with Diabetes on the Register
3590 3487 3548 4177 4372 4862 5167 5482 5393 5413
2338627432
31704
37286
42017
48972
5459957167 56036
61583
0
10000
20000
30000
40000
50000
60000
70000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Year
No. o
f Cas
es
New registered diabetic Total registered diabetic
Annual Health Reports 2000-2009
>40 years population= 535344 (2011 data )
=11.50%
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Ministry of HealthOman
40-59 Years Old Most Affected
0
200
400
600
800
1000
1200
1400
1600
1800
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Year
No.
of C
ases
20-29
30-39
40-49
50-59
60-69
70+
Annual Health Reports 2000-200913
Ministry of HealthOman
Action by in MOH
• High Political Commitment
• Established NCD Department 2003– Priority Diseases section (DM, CVD, Cancer,
Renal)– Specific Diseases (eye, ear)– Mental Health– Tobacco Control
• Formation of National Diabetes Committee
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Ministry of HealthOman
Surveillance of NCDs• Oman-pioneered applying the WHO
protocol for the Diabetes Survey in 1991,• Then Surveys were carried out 10 yearly-
in 2000, and 2008(as part of Oman WHS
• National Diabetes Register
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Ministry of HealthOman
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Baseline
First Year
Five years
Twelve years
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•Risk Factors(enter the number) •Weight( Kg )• Height (cm)• Duration of Diabetes•Clinical findings - Blood Pressure Peripheral Pulses Neuropathy Fundus Retinopathy Foot Ulcer •Laboratory Investigations -Blood Glucose-(Fasting &2 hrs pp) -OGTT –(fasting & 2 hr pp) -Fasting Lipids-(cholesterol, LDL, HDL,TG) -Renal Function ( Blood urea, creatinine, Urine-protein, sugar, ketones) -HbAIC -ECG•Type of Diabetes •Treatment • Remarks
Ministry of HealthOman
Actions: At District Hospital
–Distinct clinic for diabetes• Specialist physician
• Nurse
• “Educator”
–Medication for Rx of DM-–Glycated HbA1c
•Insulin•Oral hypoglycemics•Antihypertensives•Statins are available at all Care levels.The Higher PHC Committee and Diabetes Committee will approve new medicines as per requirement 17
Ministry of HealthOman
Diabetic clinics in Poly Clinics
8
10
12
14
16
18
20
2005 2006 2007 2008 2009
Year
Clin
ics
diabetic clinics in PC
Target by 2010
Department of NCD, MOH, Oman
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Ministry of HealthOman
Combined Clinics
0
5
10
15
20
25
2005 2006 2007 2008 2009
Year
Cli
nic
s
DM & Obgyn
Target
Department of NCD, MOH, Oman
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Ministry of HealthOman
At PHC level
30
61
88 90100
50 50 50 50 50
0
20
40
60
80
100
120
2005 2006 2007 2008 2009
Mini Diab & HTN ClinicsTarget
Department of NCD, MOH, Oman
Increase in Mini-Diabetes Clinic
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Ministry of HealthOman
… At PHC • Training of GPs
and Nurses
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Ministry of HealthOman
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Ministry of HealthOman
Diabetic FootTraining Omanis on Podiatry (Outside Oman) + (in Oman)
• In 2008 , 5 Omanis were sent to Australia for doing their BSc IN Podiatry at La Trobe University
• They then carried out Training for Nurses in Podiatry in Oman.
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Ministry of HealthOman
Training for Nurses in Podiatry carried out by Glasgow Caledonia University
24
Ministry of HealthOman
Nurse-Run in Foot Clinics
1 1 1
15
23
0
5
10
15
20
25
2005 2006 2007 2008 2009
Year
No
. of
Clin
ics
Diabetic Foot Clinics
Department of NCD, MOH, Oman
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Ministry of HealthOman
1
2
4
5
3
23
1
1
0
1
Distribution of Diabetes Foot
Clinics (April 2009)
UAE
Yemen
Kingdom of Saudi Arabia
Arabian Sea
Oman Sea
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Ministry of HealthOman
Reduction in Amputation
05
10
1520253035
404550
2001 2002 2003 2004 2005 2006 2007 2008 2009
Year
Am
pu
tati
on
s/1
0,0
00
Pa
tie
nts
/yr
Foot amputation
Department of NCD, MOH, Oman
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Ministry of HealthOman
SCREENING TOOLS
Secondary Prevention
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Ministry of HealthOman
Non-Invasive Tool
Diabetes Risk Score(Has Not been implemented in Oman
as Screening for Common NCDs
for >40 years old
is implemented
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Ministry of HealthOman
2.4.1 The National NCD Screening Program 2006
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Ministry of HealthOman
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Ministry of HealthOman
In PHC• Screening for common NCD
conditions: (only for 40+ years)
– Diabetes (FBS)– Hypertension (BP measurement)– Chronic Renal disease (GFR)– Dyslipidaemia (TC, HDL, LDL, TG)– Obesity (BMI, WC)
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Ministry of HealthOman
NCD Screening Results (2008)
No. Screened
Males Females Both
6,785 (38%)
10,894 (62%)
17,679
BMI>30 23% 36% 31%
Abnormal WC
54% 76% 68%
Pre-HTN 15% 14% 14%
HTN 21% 19% 19%
Pre-DM 36% 35% 35%
DM 8% 6% 7%
High Choles. 43% 47% 46%
eGFR < 90 32% 26% 28%33
Ministry of HealthOman
At Community Level
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Ministry of HealthOman
Community Based Initiatives
• The Nizwa Healthy Lifestyle project – WHO Community Based Program supported by MOH.
-1st baseline risk factor survey.
- In 2010 Evaluation of project was done by
WHO Consultant.
-It has been extended to other areas like Sur etc.
• School Health Program -The Health Promoting Schools program
-Facts of Life
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Ministry of HealthOman
Tobacco Control Oman
• Oman Ratified FCTC 2005
• Smoking ban in all public places
• Pictorial Health Warning ( all GCC)
• Maintaining the status quo is a big challenge
-due to tobacco lobbyists
-Increased Shisha useage in
older age group in both men and women
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Ministry of HealthOman
Challenges (1)• PHC structure needs further changes• Inadequate number trained staff to deal with
complex NCD conditions• Unavailability of latest medications
(e.g.insulin Analogue) due to cost constraints
• Limited lab services for tests in PHC –No electronic linkages for test results from Hospitals
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Ministry of HealthOman
• Need for electronic record system for defaulters follow-up, monitoring & evaluation
• Shortage of health educators
Challenges (2)
38
Ministry of HealthOman
Thank You
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