Chronic Respiratory Chronic Respiratory Diseases and Other Diseases and Other NoncommunicableNoncommunicable

Diseases in EGYPTDiseases in EGYPT

Prof. Mohamed Prof. Mohamed AwadAwad Tag El DinTag El Din

Professor of Thoracic Medicine Professor of Thoracic Medicine

AinAin Shams University Shams University

Chairman of The Egyptian Society of Chest Chairman of The Egyptian Society of Chest

Diseases and TuberculosisDiseases and Tuberculosis

One

“One year lost to poor health.”

Disability Adjusted Life Year

Murray and Lopez, Science, 1996

The DALY: A Comparative The DALY: A Comparative

Tool to Measure HealthTool to Measure Health

Females

25%

61%

10%4%

I. Communicable,maternal,perinatal andnutritional condit

II.Noncommunicable diseases

III. Ill definedcauses

IV. Injuries

Males

20%

61%

10%9%

Distribution of Burden of Diseases in Egypt 1999

The Burden of Diseases

among males and

females is increasingly

represented by Chronic

Non Communicable

Disease (> 60 %) similar

to the developed

countries

Tuberculosis notification rates, by country, 2006Tuberculosis notification rates, by country, 2006

Trend in the Annual risk of Tuberculosis Infection Trend in the Annual risk of Tuberculosis Infection

(ARTI) per 100k of population from 1951 (ARTI) per 100k of population from 1951 –– 2003 in Egypt 2003 in Egypt

20072007Data and IndicatorsData and Indicators

EgyptEgypt

Case DetectionCase Detection2007

Case Detection Rate: 67%Case Detection Rate: Case Detection Rate: 6767%%

10040100407777126126382382287228721700170048834883TotalTotal

19619600000033331717146146Private sectorPrivate sector

58580000111010004747PolicePolice

9797000000303039392828African refAfrican ref

23123144557744444949122122Non NationalNon National

4414413311332092098787138138UniversityUniversity

1124112455553434322322282282476476HIOHIO

3173173333141423232929245245PrisonPrison

757675766262112112323323220122011197119736813681NTPNTP

TotalTotalTAITAITTT TTT

FailureFailureRelapRelap

seseExtra Extra

PulmPulm..New SSNew SS--

veveNew New

SS+veSS+veEGYPTEGYPT

Case DetectionCase Detection2007

0

2000

4000

6000

8000

10000

12000

2007 4883 1700 2872 382 126 77 10400

New SS+ve Relapse TTT Failure TAI New SS-ve Extra Pulm. Total

DOTS StrategyDOTS Strategy

DOTS means directly observed DOTS means directly observed

treatment with short course treatment with short course

chemotherapychemotherapy

MDR TBMDR TB

Multi Drug Resistance Multi Drug Resistance

TuberculosisTuberculosis

Magnitude of The MDRMagnitude of The MDR--TB Problem inTB Problem in EgyptEgypt

According to the last tuberculosis drug resistance survey done in Egypt,

2002, in which a total number of 849 patients enrolled, 632 new and 217

old patients.

7.8%7.8%15%15%Streptomycin SMStreptomycin SM

0.9%0.9%0.5%0.5%EthambutolEthambutol EE

6.9%6.9%3.5%3.5%Rifampicin RFRifampicin RF

2.8%2.8%2.7%2.7%IsoniazidIsoniazid INHINH

Among retreated Among retreated patientspatients

Among new Among new patientspatients

MONORESISTANCEMONORESISTANCE

25.3%25.3%1.4%1.4%INH + RF + E + SMINH + RF + E + SM

9.7%9.7%0.8%0.8%INH + RF + SMINH + RF + SM

0.9%0.9%0%0%INH + RF + EINH + RF + E

2.3%2.3%0%0%INH + RFINH + RF

Among retreated Among retreated patientspatients

Among new Among new patientspatients

MULTIPLE DRUG MULTIPLE DRUG RESISTANCERESISTANCE

Treatment Regimens for MDRTreatment Regimens for MDR--TB in TB in

EgyptEgypt

Regimen IIIRegimen III3 months streptomycin daily + Ethambutol + Pyrazinamide + Ofloxa3 months streptomycin daily + Ethambutol + Pyrazinamide + Ofloxacin cin

+ PAS then:+ PAS then:

6 months streptomycin 5 times a week + previous drugs then:6 months streptomycin 5 times a week + previous drugs then:

12 months: Ethambutol + Pyrazinamide + Ofloxacin + PAS12 months: Ethambutol + Pyrazinamide + Ofloxacin + PAS

RHRH

Regimen IIRegimen II3 months: canamycin + Ofloxacin + Ethambutol + Ethionamide + 3 months: canamycin + Ofloxacin + Ethambutol + Ethionamide +

Cycloserine then:Cycloserine then:

6 months: canamycin 5 times a week + previous drugs then:6 months: canamycin 5 times a week + previous drugs then:

12 months: Ofloxacin + Ethambutol + Ethionamide + Cycloserine12 months: Ofloxacin + Ethambutol + Ethionamide + Cycloserine

RHSRHS

Regimen IRegimen I3 months: canamycin daily + Ofloxacin + Cycloserine + Ethionamid3 months: canamycin daily + Ofloxacin + Cycloserine + Ethionamide + e +

PAS then:PAS then:

6 months canamycin 5 times a week + previous drugs then:6 months canamycin 5 times a week + previous drugs then:

12 months Ofloxacin + Cycloserine + Ethionamide + PAS 12 months Ofloxacin + Cycloserine + Ethionamide + PAS

RHSERHSE

Treatment regimenTreatment regimenPatient Patient ResistantResistant

Asthma Asthma

Asthma in North AfricaAsthma in North Africa

Global Initiative for Asthma (GINA) 2004.

Asthma Prevalence in Middle EastAsthma Prevalence in Middle East

�� The mean prevalence of asthma among Middle The mean prevalence of asthma among Middle

East countries is East countries is 5.8%5.8% and and 3.9%3.9% among North among North

Africa countries Africa countries ((MasoliMasoli et al., 2004).et al., 2004).

�� The prevalence of asthma among Egyptian The prevalence of asthma among Egyptian

children aged 3children aged 3--15 years was estimated to be 15 years was estimated to be

8.2%8.2%. Of major concern is a . Of major concern is a 10%10% annual annual

increase in mortality increase in mortality (El(El--HefnyHefny et al., 1991; et al., 1991; KhedrKhedr et al., 1998).et al., 1998).

Asthma in EgyptAsthma in Egypt

�� The burden of asthma is higher than generally The burden of asthma is higher than generally

recognized, particularly in children. recognized, particularly in children.

�� For example, in Egypt up to For example, in Egypt up to one in four children one in four children

with asthma is unable to attend school regularlywith asthma is unable to attend school regularly

because of poor asthma control.because of poor asthma control.

Global Initiative for Asthma (GINA) 2004.

Asthma Burden

�� In some areas of Egypt asthma is the most In some areas of Egypt asthma is the most

common cause of common cause of hospitalhospital admissionadmission for a for a

respiratory complaint in adults respiratory complaint in adults ((BassiliBassili et al., 2000).et al., 2000).

�� In Egypt up to In Egypt up to one in fourone in four children with asthma is children with asthma is

unable to attend school regularly because of unable to attend school regularly because of

poor asthma control poor asthma control ((BassiliBassili et al., 2000).et al., 2000).

Lung Cancer in EgyptLung Cancer in Egypt

�� The frequency of lung cancer at the National The frequency of lung cancer at the National

Cancer Institute in 2004 showed 10.556 new cases Cancer Institute in 2004 showed 10.556 new cases

mostly from Cairo and Giza: Respiratory system, mostly from Cairo and Giza: Respiratory system,

552 cases lung cancer males 6.4%, female 1.4% 552 cases lung cancer males 6.4%, female 1.4%

median age 56 years (lung cancer).median age 56 years (lung cancer).

�� Lung cancer in Egypt is on the rise from 1990Lung cancer in Egypt is on the rise from 1990--

1997 it was 2.22% for males and 0.45% for 1997 it was 2.22% for males and 0.45% for

females. females.

�� Out of all cancer cases, Out of all cancer cases, mesotheliomamesothelioma represents represents 0.5% and is mainly caused by exposure to asbestos 0.5% and is mainly caused by exposure to asbestos and is now a problem in Egypt and the incidence is and is now a problem in Egypt and the incidence is rising.rising.

�� Since 2004 , Asbestos Industry is prohibited in Since 2004 , Asbestos Industry is prohibited in Egypt.Egypt.

�� Analysis of 7457 new cancer cases in Egypt from 8 Analysis of 7457 new cancer cases in Egypt from 8 cancer centers collected by the Central Cancer cancer centers collected by the Central Cancer RegistryRegistry showed that lung cancer constitutes 5% of showed that lung cancer constitutes 5% of all cases during the year 2004.all cases during the year 2004.

Lung Cancer in EgyptLung Cancer in Egypt

30%

17%

15%

15%

6%

3%

5%

4%3% 2%

Breast

Lymph-

nodsBladder

Liver

Blood

Colon

Lung

Unknown

Ovary

Cancer cases collected by the Central Cancer cases collected by the Central

Cancer Registry in the year 2004Cancer Registry in the year 2004

2231

62

78

9

96

46

16

0

20

40

60

80

100

120

Domiatt Damanhour Tanta Elminia Elsalam, Nasser, Sohag, Aswan

Number of Cases

Lung Cancer Cases Reported From 8

Cancer Centers Year 2004

National Smoking Prevalence Survey Egypt 2004-2005

Smoking Prevalence in Egypt

Preliminary results of National Survey 2005

Smoking in EgyptSmoking in Egypt

�� Studies form several centers showed that the Studies form several centers showed that the incidence and prevalence of smoking is incidence and prevalence of smoking is increasing as follows:increasing as follows:

�� A sample of private secondary school (below A sample of private secondary school (below age of 20) 40% at least tried smoking, 8% age of 20) 40% at least tried smoking, 8% male smokers.male smokers.

Health profile of Egypt project: 60.000 interviews in 1985 37%

National atherosclorsis study: 5.000 samples 48%- 53%

2005

70%

N one

C i g a r e t t e s

Sh i s h a

B o t h

30% smoking

6% Shisha

4% both

Prevalence of Smoking among Adult Males in Egypt

Smoking is less than 1% among femalesNational Household Survey in All 27 Governorates in Egypt sample over 5000 individuals.

Providing evidence of country specific

magnitude of impacts of tobacco on health

A study was done to estimate the burden of

tobacco use in the country on mortality and

morbidity:

23,000 deaths annually (8% of total adult

deaths/year) were due to cigarette smoking .

• There was evidence of large smoking effects

on TB mortality

9808; 42%

3692; 16%

2416; 11%

3215; 14%

2415; 11%

1316; 6%

Heart Diseases

Cerebrovascularaccidents

Vascular Diseaes

Hypertension

Malignant Neoplasms

Chronic ObstructiveAirwayDiseases+pneumonia

Smoking Disease Burden in Egypt 1999Overall Mortality 400,000 Total deaths ≥35 Years =302885

Smoking Deaths = 22862 or 8% (13% in Males, 1% in females)

�� Smoking Related Mortality ( 8%) of all deaths Smoking Related Mortality ( 8%) of all deaths

> 35 years (13% among males and 1% > 35 years (13% among males and 1%

among females). among females).

�� Disability adjusted Years of life lost (DALYS) Disability adjusted Years of life lost (DALYS)

due to smoking related diseases were due to smoking related diseases were

estimated at 288325 years estimated at 288325 years

�� This figure was about 10% of DALYS lost due This figure was about 10% of DALYS lost due

to all diseases among males and 0.6% among to all diseases among males and 0.6% among

females.females.

Smoking Disease Burden in Egypt 2004

45%

15%

11%

11%

10%

8%Heart Disease

Cerebrovascularaccidents

Chronic ObstructiveLung Disease+Pneumonia

Vascular Diseases

Hypertension

All cancers

Overall Mortality 430,000 Total deaths ≥35 Years =348501

Smoking Deaths = 37533 or 11 % (19% Males, 1.2 % Females)

Smoking ControlSmoking Control

Community–based

Comprehensive Smoking

Control Centers

1. Legislation

2. Primary prevention in adolescence

3. Laboratory surveillance

4. Cessation & comprehensive services

5. Smoke-free institutions

MOHP StrategyMOHP Strategy

Healthy Egyptians 2010Healthy Egyptians 2010

�� A prevention curriculum in schools. surveillance A prevention curriculum in schools. surveillance

system are also included..system are also included..

�� enforcement of the current laws which prohibit enforcement of the current laws which prohibit

all forms of tobacco product advertisingall forms of tobacco product advertising

�� increasing the cost of tobacco products.increasing the cost of tobacco products.

�� Nicotine addiction services in conjunction with Nicotine addiction services in conjunction with

National Insurance and a National AntiNational Insurance and a National Anti--Smoking Smoking

Campaign Campaign

�� Surveillance Surveillance

Health IndicatorsHealth IndicatorsHealth IndicatorsHealth Indicators

in Egypt in Egypt in Egypt in Egypt 2004200420042004

Health IndicatorsHealth IndicatorsHealth IndicatorsHealth IndicatorsHealth IndicatorsHealth IndicatorsHealth IndicatorsHealth Indicators

in Egypt in Egypt in Egypt in Egypt in Egypt in Egypt in Egypt in Egypt 20042004200420042004200420042004

ا5EF2ز اC12آAي 2?<;=>9 ا2;9:5 وا5067ء: ا012/ر

37.5

31.7

26.9 26.7 26.3 26.1 25.8

0

5

10

15

20

25

30

35

40

1980 1990 2000 2001 2002 2003 2004

Crude Birth Rate per 1000 population

6.46.486.376.1

6.77.1

89

10

0

2

4

6

8

10

12

1981 1985 1990 1995 1999 2000 2002 2003 2004

Crud Mortality rate per thousand

ا5EF2ز اC12آAي 2?<;=>9 ا2;9:5 وا5067ء: ا012/ر

ا5EF2ز اC12آAي 2?<;=>9 ا2;9:5 وا5067ء: ا012/ر

27.5

24.3

20.8 20.4 19.9 19.6 19.4

0

5

10

15

20

25

30

1980 1990 2000 2001 2002 2003 2004

Rate of Natural Increase per 1000 Population

اIN02اCKL1M/2اIJاGH12 : ا012/ر

5.3

3.93.5

3.2

0

1

2

3

4

5

6

1980 1992 2000 2004

Fertility Rate/Woman 2004

68.4

52.7

72.8

57.7

0

10

20

30

40

50

60

70

80

1976 ذآLر2004 ا5Qث

ا5EF2ز اC12آAي 2?<;=>9 ا2;9:5 وا5067ء: ا012/ر

Life Expectancy at Birth

Males Females

Under 5 Mortality rate/1000 live birthsUnder 5 Mortality rate/1000 live births

28.630.2

70 63.756.5

40.435.9 32.5 31.3

0

10

20

30

40

50

60

70

80

1981 1985 1990 1995 1999 2000 2002 2003 2004

Under 5 Mortality rate/1000 live births

Infant Morality rate/1000 live birthsInfant Morality rate/1000 live births

22.423.7

62

45.640

28.825 25 24.4

0

10

20

30

40

50

60

70

1981 1985 1990 1995 1999 2000 2002 2003 2004

Infant Morality rate/1000 live births

Number of Polio CasesNumber of Polio Cases

11

2951

564 539

71 9 3 70

500

1000

1500

2000

2500

3000

3500

1981 1985 1990 1995 1999 2000 2002 2003 2004

Number of Polio Cases

67.668.9

174

10085 84 74

0

20

40

60

80

100

120

140

160

180

200

1981 1985 1990 1995 1999 2000 2002 2003 2004

Maternal Mortality rate/100.000 live births

Maternal Mortality rate/100.000 live births

39.1

67.3 70.5

0

10

20

30

40

50

60

70

80

1995 2000 2004

Source : DHS

% of Pregnant Women taking Antenatal Care

23.7

45.852.7

0

10

20

30

40

50

60

1997 2002 2004

DEFG تIJKLMN داتQRSا DTJU

% of Delivery at Health Facility

Source : DHS

46.3

60.969.4 71.7

0

20

40

60

80

1995 2000 2003 2004

(DVWMX-YETZ) [T\]Sا ^_W\`Sا DaWbMN داتQRSا DTJU

% of Delivery by Trained Personal

( physician-nurse)

Source : DHS

3.6 3.6

3

2.1

0

1

2

3

4

1997 2000 2003 2004

D\_IcWSا [dc eXIFSدد اWf gKRhX

Average Number of Antenatal Care

Visits

Source : MOHP

Percentage of Stunted Growth Below 5 Years of Percentage of Stunted Growth Below 5 Years of AgeAge

29.8

24.9

20.6 18.6

15.6 15.6

0

5

10

15

20

25

30

35

1995 1997 1998 2000 2003 2004

Percentage of Stunted Growth Below 5 Years of age

Incidence Rate of S. Incidence Rate of S. MansoniMansoni Per 100Per 100

1.9

38.6

16.4 14.8 14.5

4.8 4.2 2.70

5

10

15

20

25

30

35

40

45

1981 1985 1990 1995 1999 2000 2003 2004

Incidence rate of S. Mansoni Per 100

1.6

35

11.9

6.6 5.43.2 3 1.9

0

5

10

15

20

25

30

35

40

1981 1985 1990 1995 1999 2000 2003 2004

Incidence rate of S. Hematobium Per 100

Incidence rate of S. Incidence rate of S. HematobiumHematobium Per 100Per 100

Incidence rate of Malaria Per 100Incidence rate of Malaria Per 100

0 0

0.3

0.1

0.040.01 0 0 00

0.05

0.1

0.15

0.2

0.25

0.3

0.35

1981 1985 1990 1995 1999 2000 2002 2003 2004

Incidence rate of Malaria Per 100

Number of Tetanus Number of Tetanus NeonatorumNeonatorum CasesCases

71117

6924 6633

3275

790383 331 175

0

1000

2000

3000

4000

5000

6000

7000

8000

1981 1985 1990 1995 1999 2000 2002 2003 2004

Number of tetanus neonatorum cases

Number of Diphtheria CasesNumber of Diphtheria Cases

00

725663

5914 2 0 0

0

100

200

300

400

500

600

700

800

1981 1985 1990 1995 1999 2000 2002 2003 2004

Number of Diphtheria Cases

19.7321.3

14 14

18.5616.13 16 16 16

0

5

10

15

20

25

1981 1985 1990 1995 1999 2000 2002 2003 2004

Incidence rate of tuberculosis per 100.000

Incidence Rate of Tuberculosis per 100.000

Infrastructure for Chest Diseases Services Infrastructure for Chest Diseases Services

Total number of chest diseases facilities: 150Total number of chest diseases facilities: 150

�� 111 Chest Diseases Clinics111 Chest Diseases Clinics

�� 39 Chest Diseases Hospitals39 Chest Diseases Hospitals

�� 9 Respiratory intensive and intermediate care 9 Respiratory intensive and intermediate care unitesunites

�� 5 thoracic surgery unites5 thoracic surgery unites

�� 12 12 BronchoscopyBronchoscopy unites in 10 hospitals and 2 unites in 10 hospitals and 2 clinicsclinics

�� 3 3 ThoracoscopyThoracoscopy unitesunites

Health Personnel's in Chest FacilitiesHealth Personnel's in Chest Facilities

Total number of Chest Physicians: Total number of Chest Physicians: 883883

�� No. of Chest consultants: No. of Chest consultants: 6161

�� No. of Chest Specialists:No. of Chest Specialists: 334334

�� No. of Assist. Chest Specialists: No. of Assist. Chest Specialists: 195195

�� No. of Chest Residents:No. of Chest Residents: 293293

Total number of NursesTotal number of Nurses 15981598

Cases admitted to Giza Chest Hospital Cases admitted to Giza Chest Hospital

(2001(2001--2002)2002)

PercentPercentNumberNumberPercentPercentNumberNumber

100%100%

16%16%

4%4%

2%2%

12%12%

31%31%

36%36%

44%44%

8%8%

8%8%

1%1%

9%9%

29%29%

44%44%

21502150703703OthersOthers

135741357483978397Total number of Total number of casescases

591591664664TuberculosisTuberculosis

215215118118Chest Chest tumourstumours

16081608788788PenumoniaPenumonia

4150415024392439C.O.P.D + Br. C.O.P.D + Br. ASTHMAASTHMA

4860486036853685BronchitisBronchitis

2002 2002 2001 2001

DiagnosisDiagnosis

Acute Respiratory Infections Acute Respiratory Infections

Control ProgramControl Program

Acute Respiratory Infections Control Acute Respiratory Infections Control

ProgramProgram

�� In 1989 the MOH initiated a national program to In 1989 the MOH initiated a national program to combat combat Acute Respiratory InfectionsAcute Respiratory Infections ((ARI) ARI) problems. problems.

�� The Overall Goal of the ARI Program is to The Overall Goal of the ARI Program is to reduce infant and child morbidity and morality for reduce infant and child morbidity and morality for ARI by provision of Standard Case Management ARI by provision of Standard Case Management (SCM) in the PHC facilities and hospitals, and to (SCM) in the PHC facilities and hospitals, and to educate the public to know and act promptly on educate the public to know and act promptly on the signs and symptoms of severe ARIthe signs and symptoms of severe ARI