31 st Annual National Conference of IAPSM, Chandigarh 27-29 February 2004 Non Communicable Non Communicable Diseases Surveillance Diseases Surveillance in India in India Dr. Bela Shah Sr. Deputy Director General Division of Non-communicable Diseases Indian Council of Medical Research New Delhi
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Non Communicable Diseases Surveillance in India 31 st Annual National Conference of IAPSM, Chandigarh 27-29 February 2004 Non Communicable Diseases Surveillance.
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31st Annual National Conference of IAPSM, Chandigarh 27-
29 February 2004 Non Communicable Diseases Non Communicable Diseases
Surveillance in IndiaSurveillance in India
Dr. Bela ShahSr. Deputy Director General
Division of Non-communicable DiseasesIndian Council of Medical Research
New Delhi
Deaths due to Non-communicable and Communicable diseases 1990-2020
India, and World (Males)
5561
6672
3326
2014
41
50.558
66
50
38.530
22
0
10
20
30
40
50
60
70
80
90
1990 2000 2010 2020
Year
World NCD
World CD
India NCD
India CD
ESTIMATED & PROJECTED MORTALITY RATE FOR CAUSES OF DEATH (PER 100,000)
GoalTo develop a sustainable system for NCD Surveillance in India
AimTo set up Regional Sentinel HealthMonitoring Centers for NCDs in India
Following Six centers are carrying out the study, representing 5 Geographic Regions of India
North HaryanaDelhi
CRHSP, BallabhgarhIHBAS, Delhi
South Tamilnadu MDRF, Chennai
East Assam RMRC, Dibrugarh
West Kerela SCTIMS, Thiruvanathapuram
Central Maharashtra GMC, Nagpur
Risk Factors•Tobacco - Current, past, and never. Age of initiation
– Smoking form and nonsmoking form (orally consumed and application forms).
•Alcohol - regular, (age of initiation also) occasional, past, and never. Type of alcohol. Country liquor, IMFL. •Diet- consumption of fruits, vegetables, non-vegetarian food and oil/fat used.•Physical activity- type and degree•Measurements- Blood Pressure, Pulse rate, Waist circumference
Step 3
Comprehensiveness
Co
mp
lexi
ty
Step 2
Step 1Core
Expanded
Optional
The WHO STEPwise approach to Surveillance (STEPS) of NCD Risk
Factors
At each step
The WHO STEPS approach
Levels of Risk Factor Surveillance at each StepMeasures
Level
Step 1
(Verbal)
Step 2
(Physical)
Step 3
(Biochemical)
Core Demographics,Tobacco, Alcohol,
Nutrition,
Physical activity
Measuredweight + height,
Waist girth,
Blood pressure
Cholesterol,
Fasting bloodsugar
Expanded Education,OccupationIndicators,
Hip girth, HDL-Chol,
Triglycerides
Optional Knowledge+attitudes regardinghealth Health-relatedQuality of life andhealth-relatedbehaviour
Skinfolds,Pedometer
Urine, etc.
The WHO STEPS approach
Sample Size
Rural (Male+Female) 3750
Urban (Male+Female) 3750
Total for each Regional Centre 7500
Total for Six Centers(Includes 5000 respondents for IHBAS center)
42500
BEHAVIOURAL RISK FACTORS
“Actions/Behaviour that people engage in that put their health at risk”
NCDs
• Diseases of affluence
• Diseases due to urbanization
• Diseases of developed world
• Chronic diseases
Biobehavioural disorders
HEALTHY WORKPLACESINDIAN EFFORTS
2001-2002 Surveillance of CVD risk factors in 10 major industries across India-
Baseline Survey (in collaboration with CII, MoHFW and WHO)
2003-2004 Development and implementation of health interventions; surveillance of
cause-specific mortality; event registries.
EXTENSIVE BASELINE SURVEY FOR CVD RISK FACTOR AND DETERMINANTS
10 INDUSTRIES TWINNED
WITH MEDICAL COLLEGES
Further surveillance of CVD RF/Determinants for trends
HEALTH EDUCATION AND PROMOTION
COST-EFFECTIVE ALGORITHMS FOR IDENTIFICATION AND PREVENTION OF ACUTE AND CHRONIC CVD
Ascertainment and Monitoring of CVD morbidity and mortality
Study Locations
1. New Delhi
2. Lucknow
3. Ludhiana4. Pune
5. Nagpur
6. Dibrugarh
7. Coimbatore
8. Hyderabad
9. Bangalore
10. Trivandrum
11. Chennai (affiliate center)
Coordinating Center: New Delhi
Study Centers:
Distribution of BMI in Industrial Population Sentinel
Surveillance study
BMI (kg/m2) Male Female
• >23 58.9 63.5
• >25 34.7 43.3
• >27 16.7 26.7
The Concept of IDSP
• Decentralized
• Integrated
• Action oriented
• Bring together both the communicable and non communicable diseases under one surveillance activity.
Background of IDSP
• World Bank funded project through MoH&FW
• Surveillance of infectious and Non- communicable (NCD) diseases share common infrastructure, processes and personnel
• A coordinated approach to data collection, analysis, interpretation and dissemination will facilitate planning and implementation of intervention programs.
DGHS(Co-Chair)
NPO(Cancer, MH)
IMA
NGO
Consultants
Rep.Min Environment NSO
(Member Secretary)
Rep.MOH
DirectorNIB
DirectorNICD
JS(FA)
JS(Welfare)
JS(Health)
DG, ICMR
National Surveillance* Committee
* Chairperson: Secretary Health or Secretary Family Welfare (to alternate)
Organogram National Surveillance Committee
Director HealthServices
State Program Officers
Data ManagerIDSP
Head StatePublic Health
State Trainingofficer
Environment
IMASSO
(Member Secretary)
Min. Home
State coordinator
Medical colleges
NGO
Water board)
DME)
Director (PH)Co-Chair
State Surveillance* Committee
* Chairperson: State Secretary Health
Organogram State Surveillance Committee
Aims of IDSP- NCD risk factor surveillance
1. Monitor trends of important risk factors of NCD in the community over a period of time
2. Evolve strategies for interventions of these risk factors so as to reduce the burden of diseases due to noncommunicable diseases
3. Strengthen NCD surveillance at District level4. To integrate the NCD risk factor surveillance with
IDSP 5. Evolve a data bank
Partners
• Ministry of Health & Family Welfare
• ICMR
• IndiaCLEN
• World Bank
• WHO
• State & District level Surveillance Officers
Research Surveillance Health Policies and programmes
Information
influence
evaluate
Characteristics of a surveillance system
Suggested Strategies for NCD SURVEILLANCE in India
• Integrated national surveillance programme
• Include Comm. Disease and Selected NCDs/ Risk Factors
• Identify populations for development of NCD Risk Factor surveillance module
• Utilize medical schools/ students for implementation
SUGGESTED STRATEGIES for NCD SURVEILLANCE in INDIA
• Initiate National level control programmes
• Establish govt. policies for programme implementation
• Encourage surveillance for NCDs
• Incorporate findings of surveillance into national programmes for Intervention
USERS OF SURVEILLANCE DATA
• Policy Makers & Programme implementors
• Researchers and Public Health specialists
• Collateral agencies- food manufacturers, sports equipment,tobacco industry
• Public, Media
• Associations, Universities
• Donors, private medical services
Key messages
• Recognize the emerging epidemic
• Effective interventions exist
• Partnerships to implement existing knowledge
• Set surveillance systems in place now,
focus on risk factors
• Use a stepwise approach
• Link to policy and planning
Current status of implementation of NCD prevention and control programmes in
SEAR CountriesCountries Tobacco
controlCVD Cancer Diabetes Integrated
control of NCDs
Bangladesh 1982 1978
Bhutan
DPR Korea 2000 2000
India 2000 1975
Indonesia 1989 1995
Maldives 2001
Myanmar 1982 1982 1996 1993
Nepal 1999 1998
Srilanka 1999 2000 2000
Thailand 1988 1988 1988 1988 1993
Note: Shaded areas indicate existence of a plan and the year of implemenation
Source:Non-Communicable Diseases in South-East Asia Region, A Profile, WHO, 2002
Source of NCD related data on the member countries in the region
Mortality Medical Certifictn of DeathIndia MyanmarSri LankaThailand
Cause of death surveysDPR KoreaIndiaIndonesia
Hospital data All countries except Maldives
MorbidityDisease Registries
India (cancer)Indonesia (cancer)Thailand ( injury)Sri Lanka (cancer)
Special SurveysBangladesh DPR Korea IndiaIndonesia MaldivesMyanmar Sri Lanka
Hospital reports All countries except Maldives
Risk Factor DataRegular Surveys
Indonesia
Special Surveys
BangladeshIndiaSri LankaThailand
No information obtainedBhutanDPR KoreaMaldivesMyanmarNepal
Prevention and management of NCDs
• Generating a local information base for action• Establishing a programme for promotion of health
across life span• Tackling issues outside the health sector which
influence prevention and control of NCDs• Ensuring that health sector reforms are responsive