Chronic Non Communicable Diseases Control in Guyana

1. Chronic Non Communicable Diseases Control in Guyana Dr. Shamdeo Persaud Chief Medical Officer

2. Chronic Non Communicable Diseases • Diseases that are cause mainly due to 4 behavioral risk factors: • Tobacco Use • Harmful Use of Alcohol • Unhealthy Diet • Physical Inactivity • Examples of main chronic diseases that cause death and disability: Cardiovascular diseases, Cancers, Diabetes, Hypertension and Chronic Lung Diseases Ministry of Health, GUYANA

3. Risk Factors for Chronic Diseases: Un-modifiable • Family History • Age • Ethnicity • Gender Ministry of Health, GUYANA

4. Risk Factors - Modifiable • Tobacco Use • Risk from direct consumption • Risk from exposure to second hand smoke • Causes deaths and diseases • Lung cancers • Other cancers • Infections such as Tuberculosis • Cardiovascular diseases Ministry of Health, GUYANA

5. Risk Factors: Modifiable • Physical Inactivity • Insufficient physical activity is the leading cause of disease related mortality • 20-30% increased risk of death • Physical activity: 30 minutes of moderate physical activity on most days of the week • Key in energy expenditure and weight balance • Decreases the risk of • Ischaemic heart disease by 30% • Diabetes by 27% • Breast and colon cancers by 21-25% • Stroke and hypertension • Depression Ministry of Health, GUYANA

6. Risk Factors: Modifiable Harmful use of alcohol • Major risk factor for premature death and disability • Causing: • Cancer • Liver Disease • Cardivascular disease • Alcohol related road traffic deaths • Violence • Mental illness Ministry of Health, GUYANA

7. Situation • Population: 768,000 • Diverse ethnicity • Growing Economy • Developed habits • Fast Foods • Less walking • Increased use of vehicles • Conveniences • Television etc. Ministry of Health, GUYANA

8. Situation Tobacco: • Current adult smoking prevalence: 16% • Men = 30% • Women = 3% • Current youth tobacco use: 18% Alcohol • Current adult prevalence: Estimated 36% • Proportion of students who drank at least one drink in the past 30 days: 39.2% • Proportion of students who had their first drink before age 14 years: 79% Ministry of Health, GUYANA

9. Situation Physical activity • Over 60 percent of the population is sedentary • Percentage of students who were physically active for 1 hour on five or more days during the past week: 21.3% • Percentage of students who spent more than 3 hours per day doing sitting activities: 35.6% Ministry of Health, GUYANA

10. Cancer – Number of Deaths due to Cancer from 2004 – 2010 Ministry of Health, GUYANA

11. Cancer deaths by Gender Ministry of Health, GUYANA

12. Cancer Types Ranking of top cancers • Prostate (male) 38% • Breast (female) 23% • Cervical (female) 21% • Stomach, Colon, other bowel (both sex) 9% • Liver - 3% • Lung - 2 % • All Other – 4% Ministry of Health, GUYANA

13. Diabetes • Diabetes – • Estimated Prevalence – 6.2% of population • Approximately 47,000 persons living with diabetes • Average of 11 % (31,000) of population over 30 years • Incidence – 2,000 new cases annually • Types of Diabetes • Type 1 (Insulin Dependant) – 8% • Type 2 (non-Insulin Dependant) - 92 % Ministry of Health, GUYANA

14. Hypertensive Disorders • Prevalence – 18% of the Population over 30 years – 52,000 • Incidence – 9,000 new cases reported annually • Major contributing cause of • Strokes in persons over 40 • Heart Attacks • Disability and under productivity • Together with Diabetes – 64,000 persons • 13% (99,000) with either or both Ministry of Health, GUYANA

15. Cardiovascular and heart diseases • Strokes • Hemorrhagic – 1,901 cases annually • Thrombo-embolism (Clots) – 896 cases annually • Heart Attacks – 2,012 cases • Blood vessel disease • Atherosclerosis – 3,129 reported • Aneurysms - 0.7 % Ministry of Health, GUYANA

16. Priorities for Action and Response • Multi-sectoral response • Chronic Non Communicable Disease Commission • Comprising stakeholders • International agencies: PAHO, UN Agencies • Line Ministries and other Governmental Agencies • Non Governmental Organizations • Chaired by Minister of Health • Meets quarterly • Develop a multi-year work plan and Strategy Ministry of Health, GUYANA

17. Priorities for Action and Response • Mass Media • Television shows: • “Pulse Beat” on NCN channel 11 • “Your Health the Nation’s Wealth” on NCN channel 11 • “Changing Course” on Drug Demand Reduction, every • Radio programme: Doctor on Call, Let’s Talk about DAT (Drugs, Alcohol and Tobacco) • Radio series Merundoi incorporated CNCDs • Advertisement Print, TV and Radio • Social media?? Ministry of Health, GUYANA

18. Priorities for Action and Response • Promotion of Healthy Lifestyle Changes • Weight No More • Tracking 12 overweight and obese women over 12 weeks as they modified their lifestyles to be healthier • Health Walks • Health Fairs • Interpersonal communication and direct education at all health facilities, workplace, school and community groups Ministry of Health, GUYANA

19. Priorities for Action and Response • Screening • VIA for cervical cancer • Breast Self Examination education • Prostate and other cancers • Body Mass Index (BMI) • Waist circumference • Blood pressure • Blood glucose • Lipids and cholesterol Ministry of Health, GUYANA

20. 1. Risk Reduction: Screening in community and workplace

21. Priorities for Action and Response • Information, Education and Communication on CNCDs • Television and print advertisements • Posters • Pamphlets • Brochures • Fliers Ministry of Health, GUYANA

22. Priorities for Action and Response • Disease Management • Integrated PHC clinics • Standardized clinical guidelines for Heart Disease, Hypertension, Diabetes, Cancers and Asthma • Diabetes, cancer and other Registers • Foot, eye, kidney and heart care programs • Testing: glucometers for blood glucose measurements, HbA1c, lipid, PSA, Renal Function, heart scans, angiogram, CT, MRI • Nutrition and Lifestyle counseling Ministry of Health, GUYANA

23. You are an equal partner with your health care team • Prepare yourself for each clinic visit by writing any important information you need to share with your doctor or any questions you may have to ask. • Know what health goals you and your team have set

24. Priorities for Action and Response • Surveillance • Introduction of NCD Morbidity Reporting system (S3) • Data Base development (MIS) • Mortality Data system • Registries • Monitoring and Evaluation Indicators • Core Data and periodic surveillance • Minimum data set (CHRPHA) • Steps Surveys Ministry of Health, GUYANA

25. Priorities for Action and Response • Surveys: • Demographic Health Survey 2009 • Global School Health Survey 2004, 2010 • Global Youth Tobacco Survey 2000, 2004, 2010 • Global School Personnel Survey 2010 • Global Health Professional Student Survey 2009 • GENACIS Survey on Alcohol 2009 • Emergency Room Survey on Alcohol and Injuries 2011 • Behavioural Surveillance Survey 2004 and 2008 • BMI Registers • Food Consumption Survey • Physical Activity Survey Ministry of Health, GUYANA

26. Priorities for Action and Response • Training • Pre service training: • Health care workers: Doctors, nurses and medex • Screening and Brief Intervention for Alcohol • Motivational Interviewing for Substance Use • Mental Health – anxiety, depression, suicide • University of Guyana and Teacher’s Training College • Drug Demand Reduction, including alcohol • Tobacco control • CNCDs Ministry of Health, GUYANA

27. Priorities for Action and Response • Policies, Legislation and Regulation • Draft legislation for tobacco control • Smoke Free spaces • Labeling and advertizing • Regulation of “fast food” (Salt, Sugar, Fats) • Policy on school canteen, Dorms, feeding programs • Health Family Basket of foods – Zero Rated • Safe open spaces for physical activities • Other Health Public Policies Ministry of Health, GUYANA

28. Thank You Questions? Comments! Ministry of Health, GUYANA