Community engagement health programme at Papua New Guinea

GLOBAL PUBLIC HEALTH 2015 CONFERENCE

COLOMBO, SRI LANKAby

Dr Haireen Hadi, Dr Norita Hussein, Dr Ihsan Abu Bakar, Mr Bahrulmazi Edrak

and Ms Syahida Maamon

Content:

1. Introduction2. Objectives3. Literature review4. Methodology5. Results6. Discussion7. Conclusion8. References

Introduction• Malaysian Global Reach was developed by Ministry of Education

Malaysia to offer service to the community through education, research and transfer of knowledge in the third world countries.

• PNG was selected as one of the countries in the Malaysian Global Reach.

• With a ratio of 1 doctor to 17,000 people, health education and patients' empowerment may improve health conditions in these communities.1

• Healthy lifestyle is one of the ways to prevent the emergence of chronic illnesses which will be costly to handle numerous complications.2

Objectives:• To explore the health issues in two communities in Port

Moresby, Papua New Guinea.

• To provide demographic data of these communities

• To explore the behaviour profile of these communities

• To provide findings of non-communicable diseases of the communities

• To examine the association between the habit profile and health conditions

Literature review

• According to the WHO, Papua New Guinea has unfavourable health status in the Pacific region.1

• Cardiovascular diseases is on the rise in Papua New Guinea due to changes in lifestyle and urbanization.2

• Smoking, alcohol and betel nut chewing are crucial addictive habit problems in PNG.1

• Smoking and betel nut chewing are both associated with cardiovascular problems3 as well as linked to oral cancers.4

Methodology• Self administered questionnaires on sociodemographic and current lifestyle

• Convenience sampling was done from two villages near Port Moresby: the Tatana Village and Muslim communities in Hohola in August 2014.

• Data collected included were sociodemographics profile, habit profile which include smoking, alcohol and betel nut chewing, chronic diseases such as hypertension, diabetes mellitus and ischaemic heart disease and body mass index and infectious diseases such as malaria, dengue fever and blood borne diseases.

• Blood pressure, random blood sugar and body mass index were taken either by the attended doctors or a trained researcher and compared to self- reported data.

• Data was analysed using SPSS Version 16

Results (1)Sociodemographic of the subjects:

• Number of subjects: 131

• Mean age : 42.3 years old (SD ± 13.8 years)

• Male to female ratio: 2: 3

• 80% were married

Self- reported:• Hypertension: 17.6 %• Diabetes mellitus: 3.8%

Results (2)

Addictive habits (self- reported):

In general, men were seen to be higher in number in smoking, alcohol consumption and betel nut chewing compared to women.

1. Smoking: • Non- smoker (72%)• Current smoker (21%)• Ex-smoker (7%)

2. Alcohol consumption: • None (82%)• Seldom (14%)• Regular (4%)

3. Betel nut chewing• Yes (30 %)• No (8%)• Not reported (62%)

Results (3)

Physical findings during health survey:

1) Blood pressure• Normal (31%)• Pre- hypertension (27%)• Hypertension (37%)

2) Random capillary blood glucose• Normal (61%)• Impaired (9%)• Missing data (30%)

3) Body mass index• Normal (36%)• Over weight and obese (62%)• (under weight 1% and missing data 1%)

Results (4)

Men Women Men Women Men Women Smoking Alcohol consumption Betel nut chewing

0

5

10

15

20

25

DiabetesHypertensionIschaemic Heart Disease

Figure 1: Addictive habits and non- communicable diseases by gender

Perc

enta

ge (%

)

Results (5)

• There were about 17% of both men and women were already diagnosed with hypertension, physical findings showed that 37.7% of men and 40.3% of women had high blood pressure measurements.

• 9% of the subjects had impaired glucose testing but only 4% claimed that they were diagnosed with diabetes mellitus.

• 4.5 % of men with diabetes mellitus were also smokers.

Results (6)

• Men showed high percentage in betel nut chewing in the pre-obese group while in women, more so in the normal and pre-obese BMI

• Betel nut chewing has a significant relationship with hypertension (p= 0.018)

• 18% of men and 17% of women who chewed betel nut had a history of ischaemic heart disease and most of the chewers were in the young age groups between 25 to 54 years old.

• However, there was no significant association between betel nut chewing with diabetes mellitus and ischaemic heart disease.

Discussion• Only 7% of the subjects studied were above 65 years old with the majority studied

were being in the 35 to 54 years of age. This is in keeping with the nation’s 76% of its population are under 35 years of age and life expectancy of 63 years of age.5,6

• Lifestyle changes and urbanization seen in these two communities in PNG has caused

the rise in chronic health problems which are associated with lifestyle changes like obesity and hypertension.2

• It is interesting that the presence of high blood pressure recordings were higher than reported which gives rise to a probability of under-diagnosing the problem in both groups of men and women.

• The prevalence of diabetes mellitus in these communities were only 4% compared to 5.2% reported in IDF report in 2014.6 With the mean random blood glucose recorded in this study of 6.7 mmol/L (SD± 2.5mmol/L), diabetes mellitus is probably under- diagnosed too as mentioned in other studies.6,7.

• Betel nut chewing was significantly associated with hypertension which is similar in other studies.8

Conclusion

• Chronic illnesses like obesity, hypertension and diabetes mellitus are likely underdiagnosed and screening for these problems are crucial to prevent complications at an early age.

• Overweight and obesity is an issue that needs to be address to prevent the emergence of other chronic health problems and complications in these communities.

• Betel nut chewing is associated with hypertension and are seen mainly in the young age group which will probably impose an increased cardiovascular risk at an early age.

References1. www.adi.org.au/health-in-png-22. Cockram C S. Diabetes mellitus: perspective from the Asia Pacific region. Diabetes

Research and clinical practice 2000; 50(S2): pg S3-7.3. Chen C C et al. Association among ciggarette smoking, metabolic syndrome and its

individual components: the metabolic syndrome study in Taiwan. Metabolism 2008; 57: pg 544-548.

4. Ko Y C et al. Betel quid chewing, cigarette smoking and alcohol consumption related to oral cancer in Taiwan. Journal of Oral Pathology and Medicine 1995; 24 (10): pg 450- 453

5. www.pg.undp.org/content/papua_new_guinea/en.home.countryinfo/html6. www.idf.org/membership/wp/papua-new-guinea (extracted on 30 November 2015)7. F.I.R Martin et al. Diabetes mellitus in urban and rural communities in Papua New

Guinea. Diabetoliga 1980; 18: pg 369-374 8. Tseng C-H. Betel nut chewing is associated with hypertension in Taiwanese type 2

diabetic patients. Hypertension Res. 2008; 31: pg 417- 423