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The Non Communicable Disease Crisis and Reproductive Health

The Non Communicable Disease Crisis and Reproductive Health. PSRH BIENNIAL MEETING APIA, SAMOA, 9-12 JULY, 2013 PROF RAJAT GYANESHWAR FIJI NATIONAL UNIVERSITY. OUTLINE OF PRESENTATION. BACKGROUND LITERATURE REVIEW ANALYSIS OF IMPLICATIONS FOR THE PACIFIC RECOMMENDATIONS . DEFINITIONS.

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The Non Communicable Disease Crisis and Reproductive Health

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  1. The Non Communicable Disease Crisis and Reproductive Health PSRH BIENNIAL MEETING APIA, SAMOA, 9-12 JULY, 2013 PROF RAJAT GYANESHWAR FIJI NATIONAL UNIVERSITY

  2. OUTLINE OF PRESENTATION • BACKGROUND • LITERATURE REVIEW • ANALYSIS OF IMPLICATIONS FOR THE PACIFIC • RECOMMENDATIONS

  3. DEFINITIONS • DIABETES • CARDIOVASCULAR DISEASE • CHRONIC RESPIRATORY DISEASE • CANCER • SEXUAL HEALTH • FAMILY PLANNING AND INFERTILITY • MATERNAL AND CHILD HEALTH • STIs & CANCER NCDs RH

  4. NCD RISK FACTORS • SMOKING - foetal and maternal issues • NUTRITION - Diabetes, hypertension • ALCOHOL - foetal alcohol synd, STIs, preg, cervical ca. • PHYSICAL ACTIVITY - obesity, osteoporosis

  5. OBESITY • MENSTRUAL PROBLEMS • FERTILITY ISSUES • INCREASED PREGNANCY RISKS • URINARY AND FECAL INCONTINENCE • PELVIC FLOOR LAXITY • POST MENOPAUSAL BREAST CANCER • ENDOMETRIAL AND OTHER CANCERS.

  6. OBESITY AND MENSTRUAL PROBLEMS • Polycystic Ovarian Syndrome – obesity, excessive body hair and anovulation • Common problem in the Pacific • Weight loss is first line of treatment ( Hollmann et al. Human Reproduction. 1996;11:1884-91) • Life style factors important in achieving weight loss. ( Huber-Buchoholz M et al. J ClinEndocrinol Met. 1999;84:1490-4

  7. OBESITY AND FERTILITY • REDUCED FECUNDITY AND INCREASED TIME TO CONCEPTION ( WiseL LA et al. Human Reprod. 2010; 25:253-264) • HIGH RATES OF INFERTILITY ( British Fertility Society Policy and Practice Guidelines) • LOWER RATES OF SUCCESSFUL PREGNANCY AFTER FERTILITY TREATMENT ( Maheshwari A et al. Human Reproduction Update. 2007;13:433-444)

  8. OBESITY AND PREGNANCY INCREASED RISK OF : • DIABETES (x2 – 5 depending on BMI) • HYPERTENSION AND PET (X3.5) • PRE TERM DELIVERY • LARGE BABY AND SHOULDER DYSTOCIA • CAESAREAN DELIVERY (Linear assoc with BMI) • PPH • PULMONARY EMBOLUS • COST AND LENGTH OF STAY (( Weiss JL et al. Am J ObstetGynecol 2004, O’Brien TE eta al. Epidemiology 2003, Kabrehel C et al. Obesity 2009, Scott-Pillai R et al 2013, BJOG Torloni MR et al. J MaternFetal Neonatal Med. 2009)

  9. OBESTITY AND CANCER • INCREASED RATES OF : - POST MENOPAUSAL BREAST CANCER - ENDOMETRIAL CANCER - OTHER CANCERS - gut , liver, gall bladder, pancreas and kidney (Renehan AG et al. Lancet 2008;371(9612): 569) (Calle EE et al. N Engl J Med. 2003;348(17):1625)

  10. NCDs and Female Mortality • Each day : 50,000 women die from NCDs 1000 maternal deaths • More women die due to : cardiovascular disease cancer respiratory disease (WHO list of 10 leading causes of death in women)

  11. OBESITY IN THE PACIFIC • 33% of Fijian women (15-24 age group) are overweight or obese ( 2002 STEPS survey) • Obesity rates have trebled between 1993 and 2004. ( Fiji National Nutrition Survey 2004) • Obesity rates of between 30- 75% reported in 25-64 year olds in the Pacific (STEPS surveys)

  12. NCD RISK FACTORS - STEPS SURVEY • SMOKING – 53.2 % of women in Nauru smoke. Rates high for Kiribati,Tokelau, Wallis and Fortuna ) • ALCOHOL – 50% Cook Is women • HYPERTENSION – 27.5% American Samoan women • DIABETES – 42.4% - 12%

  13. OPPORTUNITY TO MAKE A DIFFERENCE • RISK FACTORS COMMON AND MODIFIABLE • HEALTH PRIOR TO, DURING, AND AFTER PREGNANCY AND CHILDBIRTH CAN HAVE LONG TERM HEALTH IMPLICATIONS • MCH PROGRAMS SHOULD INCLUDE NCD INTERVENTIONS

  14. PRACTICAL SUGGESTIONS • Empower women and girls to care for their health better – menstrual problems, fertility issues, pregnancy care. • New approach to pregnancy care – weight gain, - nutrition, - cancer screening, - physical activity

  15. Caring for women and girls • Emphasis on health education • Empowering women to take sound decisions about risk taking behaviour. • Take opportunity during antenatal visits to counsel, educate

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